INCRETIN MIMETICS


Stimulate insulin secretion, inhibit glucagon secretion, and suppress appetite.

Exanatide and sitagliptin use have been associated with acute pancreatitis in case reports

  1. Pramlintide (Symlin)
  1. A synthetic analogue of human amylin, a hormone secreted by pancreatic beta cells which prevents postprandial rise of glucagon; also may reduce appetite.
  2. An injectable treatment intended as an adjunct to insulin, when optimized insulin dosing fails to control glucose in type 1 or type 2 diabetics
  3. Can increase risk of hypoglycemia
  4. When starting, reduce insulin dose by 50%
  5. In type 2 DM, initiate at 60ug SQ immediately prior to meals, can increase to 120mcg as tolerated
  1. Exanitide (Byetta)
  1. A synthetic analogue of human incretin, which increases glucose-dependent insulin secretion
  2. An injectable treatment intended as an adjunct to metformin and/or sulfonylureas when they aren't controlling type 2 DM
  3. 5 mcg SQ BID, 60min before breakfast & supper; may increase to 10 mcg after 1mo
  4. May increase the risk of hypoglycemia if used with a sulfonylurea so consider reducing sulfonylurea dose when starting treatment
  5. Exenatide has been successfully combined with insulin in at least one clinical trial (Ann. Int. Med. 154:103, 2011-JW)
  6. Not intended for use in type 1 DM
  1. Luraglutide
    1. Injected SQ QD
    2. Associated with sig. greater mean declines in HbA1c than exenatide in one randomized study in type 2 diabetics (Lancet 374:39, 2009-JW)