A 58 year old woman with type 2 diabetes of 7y duration and no history of macrovascular disease. She is obese (BMI= 36 kg/m2), but says she eats a healthy diet and describes this. Her BP is 134/78 mm Hg, and she has microalbuminuria, but normal renal function and a lipid profile within target levels ranges.
Simvastatin 40 mg daily and Enalapril 20mg daily. Glycated haemoglobin (HbA1c) is 8.3% despite treatment with metformin 2000 mg/D and gliclazide 160 mg twice a day. How would you best manage her hyperglycaemia?
THE INCRETIN EFFECT AND GLUCAGON-LIKE PEPTIDE 1 THERAPY
GLP-1 a 30-amino-acid polypeptide derived from proglucagon gene
Rapidly secreted into bloodstream from enteroendocrine L-cells in distal small intestine & colon in response to food ingestion.
Within the L-cells of the small intestine, proglucagon peptide is processed by prohormone convertase to
GLP-2 (a key regulator of small intestinal growth)