Madsbad Sten, Krarup Thure, Deacon Carolyn F, Holst Jens J
Department of Endocrinology, Hvidovre University Hospital, Hvidovre and University of Copenhagen, Copenhagen N, Denmark.
Curr Opin Clin Nutr Metab Care. 2008 Jul;11(4):491-9. doi: 10.1097/MCO.0b013e328302f414.
To discuss the virtues and shortcomings of the glucagon-like peptide-1 receptor agonists and the dipeptidyl peptidase-4 inhibitors in the treatment of type 2 diabetes.
The injectable glucagon-like peptide-1 receptor agonists exenatide significantly improves glycaemic control, with average reductions in haemoglobin A1c of about 1.0%, fasting plasma glucose of about 1.4 mmol/l, and causes a weight loss of approximately 2-3 kg after 30 weeks of treatment in patients with type 2 diabetes. The adverse effects are transient nausea and vomiting. The long-acting glucagon-like peptide-1 receptor agonists liraglutide and exenatide long-acting release reduce haemoglobin A1c by about 1.0-2.0% and have fewer gastrointestinal side-effects. The orally available dipeptidyl peptidase-4 inhibitors, that is sitagliptin and vildagliptin reduce haemoglobin A1c by 0.5-1.0%, are weight neutral and without gastrointestinal side-effects.
The benefits and position of the glucagon-like peptide-1 analogues and the dipeptidyl peptidase-4 inhibitors in the diabetes treatment algorithm will be clarified when we have long-term trials with hard cardiovascular endpoints and data illustrating the effects on the progression of type 2 diabetes.
探讨胰高血糖素样肽-1受体激动剂和二肽基肽酶-4抑制剂在治疗2型糖尿病中的优缺点。
注射用胰高血糖素样肽-1受体激动剂艾塞那肽可显著改善血糖控制，2型糖尿病患者治疗30周后，糖化血红蛋白平均降低约1.0%，空腹血糖降低约1.4 mmol/L，体重减轻约2-3 kg。不良反应为短暂的恶心和呕吐。长效胰高血糖素样肽-1受体激动剂利拉鲁肽和长效释放型艾塞那肽可使糖化血红蛋白降低约1.0%-2.0%，胃肠道副作用较少。口服二肽基肽酶-4抑制剂西他列汀和维格列汀可使糖化血红蛋白降低0.5%-1.0%，对体重无影响，且无胃肠道副作用。
当我们进行有严格心血管终点的长期试验以及有数据说明对2型糖尿病进展的影响时，胰高血糖素样肽-1类似物和二肽基肽酶-4抑制剂在糖尿病治疗方案中的益处和地位将得以明确。
