Unger Jeff
Catalina Research Institute, Chino, CA 91750-3502, USA.
J Am Osteopath Assoc. 2011 Feb;111(2 Suppl 1):eS2-9.
Incretin-based therapies (subcutaneously administered glucagon-like peptide-1 [GLP-1] agonists and oral dipeptidyl peptidase-4 inhibitors) represent a new mechanism of action with which to target the adverse effects of type 2 diabetes mellitus. Both classes of incretins are excellent choices for patients who have jobs that do not permit use of insulin therapy, who have hypoglycemic unawareness, or for whom hypoglycemia is an especially worrisome potential adverse effect. Glucagon-like peptide-1 agonists are an attractive choice for patients in whom promotion of weight loss is a major consideration and the glycated hemoglobin level is moderately elevated (<8.0%) (ie, insulin is not required). Short-acting exenatide has been available since 2005 and is administered twice a day before meals. Liraglutide is the first of the long-acting GLP-1 agonists to be approved in the United States and is administered once a day. The most common adverse effects of GLP-1 agonists are those related to the gastrointestinal system. Both exenatide and liraglutide are associated with weight loss when used as monotherapy or as part of combination-therapy strategies. Glucagon-like peptide-1 agonists also have beneficial effects on cardiovascular risk factors such as blood pressure and lipids.
基于肠促胰素的疗法（皮下注射胰高血糖素样肽-1[GLP-1]激动剂和口服二肽基肽酶-4抑制剂）代表了一种针对2型糖尿病不良反应的新作用机制。对于那些工作不允许使用胰岛素治疗、存在低血糖无意识情况或低血糖是特别令人担忧的潜在不良反应的患者而言，这两类肠促胰素都是很好的选择。对于那些主要考虑促进体重减轻且糖化血红蛋白水平中度升高（<8.0%）（即不需要胰岛素）的患者，胰高血糖素样肽-1激动剂是一个有吸引力的选择。短效艾塞那肽自2005年起可用，每日两次在餐前给药。利拉鲁肽是美国首个获批的长效GLP-1激动剂，每日给药一次。GLP-1激动剂最常见的不良反应是与胃肠道系统相关的不良反应。艾塞那肽和利拉鲁肽在作为单药治疗或作为联合治疗策略的一部分使用时均与体重减轻相关。胰高血糖素样肽-1激动剂对心血管危险因素如血压和血脂也有有益作用。
