Incretin Based Therapies

Incretins are a group of gastrointestinal hormones that cause an increase in the amount of insulin released from cells in the pancreas after eating. Incretin based drugs are used to control blood sugar levels in the management of diabetes. This book is a concise guide to incretin based therapy. Beginning with an introduction to the history and physiology of incretins, the following sections examine the clinical pharmacology of GLP-1 Analogues and DPP-4 Inhibitors, the pleiotrophic effects of incretins and comparative pharmacology. Each section integrates science with practical therapeutic guidance for clinicians involved in the management of diabetes. The final chapter discusses the future of incretin therapies, including non-diabetic usage and combination therapy. Key Features Concise overview of incretin based therapy for the management of diabetes Guides clinicians step by step through the history and pharmacology of various molecules Integrates science with practical therapeutic guidance Includes chapter on the future of incretin therapy

This concise handbook provides an overview of incretin-based therapies and guidance for incorporating them into the treatment of type 2 diabetes. Chapters include landmark clinical trials and international treatment guidelines in order to update readers with all major advances in the field. An ideal resource for medical professionals that treat patients with type 2 diabetes in hospital and clinical settings.

The increasing global prevalence of type 2 diabetes represents a significant burden of disease for afflicted patients and for health care systems. In the developed world poorly controlled diabetes is the leading cause of non-traumatic amputation, blindness and end-stage renal disease requiring dialysis and kidney transplant. Additionally, diabetes represents a significant risk factor for the development of cardiovascular disease with its associated morbidity and premature death. Currently available glucose lowering drugs used to treat type 2 diabetes do not impede progression of the disease. Therefore, as the disease progresses these agents rapidly lose efficacy, first as monotherapy and then in combination, resulting in poorly controlled disease. Clearly, there is a significant need for novel glucose lowering drugs for type 2 diabetes that will deliver sustained efficacy over several years by impeding disease progression. Such agents would reduce the risk of developing the microvascular complications of diabetes that ultimately result in amputation, blindness and kidney transplant. Novel glucose lowering drugs should ideally also exhibit a positive impact on the increased cardiovascular risk associated with diabetes. The incretin-based therapies first entered the market in the mid 2000’s and were heralded for their potential to impede progression of type 2 diabetes and to reduce cardiovascular risk. Through mimicking the actions of the gut incretin hormone GLP-1, these drugs had been shown to lower blood glucose in clinical trials by potentiating glucose stimulated insulin secretion from pancreatic β-cells. Moreover, data from preclinical rodent disease models and isolated human pancreatic islets suggested that these novel agents could preserve pancreatic β-cell function and thus impede disease progression. Further preclinical and clinical data supported the notion that these drugs could also aid blood glucose control by suppressing glucagon secretion, slowing gastric emptying and by suppressing appetite. The incretin-based drugs have potential to reduce cardiovascular risk through their ability to reduce body weight, blood pressure and atherogenic blood lipids. This chapter will review the incretin-based therapies and consider what impact these new drugs have made to date in the pharmacotherapy of type 2 diabetes. The incretin-based therapies are of particular relevance to this book as this class of drugs is composed of two sub-classes, injectable peptide drugs and oral small molecule drugs. The similarities and differences between these small molecule and peptide drugs are described.

Diabetes is a huge and growing healthcare worry, especially in Western countries. The treatment of both types – 1 and 2 – of this disease has changed radically over the past few years. This work provides an overview of all the changes that will come to be implemented in clinical practice. Summarizing all aspects of treatment, this book delineates the large amount of research work that has been completed over the last few years into the relief of complications in diabetes and vascular medicine in general.

Clinical Dilemmas in Diabetes provides evidence-based clinical guidance on the most common and problematic areas of concern encountered in diagnosing, treating and managing patients with diabetes. Each chapter is highly topical and has been selected due to current interest, specific recent developments, and areas of controversy. This valuable guide provides assistance in managing the life-long treatment of diabetes and the complications that often develop in patients. Clinical Dilemmas in Diabetes guides the medical team in their decision-making, particularly when there are conflicts in the treatment for the disease and the complications. Part of the Clinical Dilemmas series, the well-focused chapter structure allows for quick retrieval of information, and each opens with a “Learning Points” box to aid easy assimilation of the main issues. With a leading team of contributors and editors, Professor Robert A. Rizza is the immediate Past-President of the American Diabetes Association. This book is perfect for use on the wards and clinics as well as for self-study by diabetologists, diabetes specialist nurses, endocrinologists, GPs and cardiologists.

Together, obesity and diabetes form a 21st century epidemic, the treatment of which consumes a substantial fraction of global health costs. New and improved therapies are therefore desperately needed. Incretins are short peptide hormones released from the gut in response to food transit. These hormones regulate a plethora of processes to control food intake, body weight and glucose homeostasis. This is one of the fastest areas of growth within diabetes research, and over the past decade, increasing numbers of novel diabetes drugs -- many based on incretin action -- have been added to the therapeutic armoury. Following an introduction detailing the historical perspective and discovery of incretin therapies and clinical applications, the book looks at the release of incretins at a cellular level from entero-endocrine cells, and actions on the pancreas (alpha and beta cells) and brain. It then looks at changes in incretins seen in diabetes and following bariatric surgery. Finally, the side effects of incretin therapy are discussed. Importantly, each chapter contains a methodology section aimed at providing a practical guide to key techniques in the field of incretin biology and ranges from basic laboratory research to clinical practice. Incretin Biology -- A Practical Guide offers a unique perspective within this field of research by bringing together scientists, physicians and bariatric surgeons. Thus, it is a comprehensive text that offers a broad overview of the subject.

Diabetes has become a worldwide health problem, the global estimated prevalence approaches ten percent and the burden of this disease in terms of morbidity and mortality is unprecedented. The advances acquired through the knowledge of the mechanisms of the disease and the variety of therapeutic approaches contrast with the inability of private and public health systems in underdeveloped and even developed countries to achieve the goals of treatment. This paradox has been described in many sources: the surge of scientific advances contrast with an unprecedented amount of human suffering. Thus, a patient centered and an evidence based approach with the capacity to produce measurable clinical and economic outcomes is required. The purpose of this textbook is multiple: to offer a comprehensive resource covering all aspects of outpatient management; to address diabetes as a health problem from an epidemiological, economic and clinical perspective; to discuss the role of social determinants of health on the worldwide increase in diabetes; to highlight the challenges and obstacles in providing adequate care; and to outline a multidisciplinary approach to management in which medical visits retain their importance as part of a team comprising the patient, his or her family and a multidisciplinary group of health professionals who are able to move beyond the traditional approach of diabetes as a disease and greatly improve outcomes.