Incretin Mimetic Agents

Gastrointestinal hormones known as incretins (such as glucagon-like peptide-1) are released during food intake, which in turn promotes insulin secretion and suppression of glucagon from the pancreas.

There are two available incretin mimetics, exanatide and liraglutide, which may lower A1C by 1 to 1.5%. Incretin mimetics improve glucose control by mimicking the effects of glucagon-like peptide-1, a natural mammalian incretin hormone. Exenatide is available as two formulations, Byetta (5 mcg–10 mcg subcutaneously BID) and Bydureon (2mg subcutaneously weekly). Liraglutide (Victoza) is dosed 0.6 mg–1.8 mg subcutaneously once daily.  These agents may cause slight weight loss (approximately 2-3 kg) due to their slowing effect on gastric motility. The most common adverse effects were nausea, vomiting, diarrhea. Patients should be closely monitored for hypoglycemia, especially when exenatide is added to sulfonylurea therapy. These agents may be associated with pancreatitis. In addition, there has been an association with thyroid cell cancer in rodents. Incretin mimetics are injectable that agents can be considered as a second line treatment option for patients with type 2 diabetes who fail to obtain glycemic control while on a maximum dose of metformin.