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Feature Article New Diabetes Treatments Start in the Gut

By Eileen Schramm, BSN

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For many years, sulfonylureas, Metformin and insulin have been the gold standard in treating diabetes. However, medical advances have shed light on new medications that are beneficial in controlling glucose levels. These drugs work with incretin hormones, which are secreted from the gastrointestinal tract, mainly the gut and small intestine.

There are two main incretin hormones called Glucagon-like Peptide-1 (GLP-1) and DPP4. GLP-1 is secreted in the intestine in response to food intake. It reduces glucose levels by helping the pancreas release more insulin. It also stops the liver from releasing stored sugar in the blood when it’s not needed, and it slows the movement of food through the stomach so sugar enters the blood more slowly.

GLP-1 has also been shown to reduce body weight. It alters the brain response to food and promotes satiety by telling our brain we are full while eating. This helps in controlling the rise of blood glucose after eating, a problem that many people with diabetes have. Because of this benefit, the U.S. Food and Drug Administration just recently approved the first manufactured GLP-1 hormone for the treatment of obesity in the U.S. GLP-1 agents are called Exanatide (Byetta), Exanatide extended release (Bydureon), Liraglutide (Victoza), Pramlintide (Amylin/ Smylin) and Albiglutide (Tanzeum). Many of these non-insulin injectable medications can be taken daily, twice a day or even once a week and are injected by pen, not a syringe.

Nausea is a common side effect but this subsides for most people after taking the medication for a few weeks.

Another newer category of diabetes medications are called DPP4 inhibitors. The DPP4 hormone breaks down the GLP-1 hormone, thus interfering with that hormone’s good work. DDP4 inhibitors slow the breakdown of GLP-1 to let it remain active longer and help lower blood glucose levels. DPP4 drugs include: sitagliptin (Januvia), saxagliptin (Onglyza), linagliptin (Tradjenta) and alogliptin (Nesina). These pills are usually taken once a day, with or without food, and have very few side effects.

Ask your provider about medications that may help with your blood glucose and weight targets. As with any medication, there are always side effects to consider, and your provider will know if you might benefit from these newer drugs.

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