Tailoring treatment for type 2 diabetes: Uncovering the HOW and NOW of GLP-1 receptor agonist therapy

Type 2 diabetes mellitus (T2DM) is a chronic, progressive disease that results from multihormonal dysregulation and is frequently accompanied by a number of comorbidities and complications. Improved glycemic control has been associated with improved microvascular outcomes, but the relationship between glycemic control and macrovascular disease is more complex. Numerous studies evaluating glycemic control and its effect on long-term outcomes have altered the paradigm of treatment for this chronic disease. Today, treatment guidelines and algorithms recommend "tailoring" T2DM therapy to the individual needs of the patient. The incretin-based therapies, including the glucagon-like peptide-1 receptor agonists (GLP-1 RAs) and dipeptidyl peptidase-4 (DPP-4) inhibitors, offer health care providers and patients expanded treatment options for T2DM. The GLP-1 RAs, with their multiple mechanisms of action, are uniquely suited to provide complementary T2DM therapy. In particular, GLP-1 RAs have been shown to provide improved glycemic control, as monotherapy or in combination with other antidiabetes agents, while exhibiting a low incidence of hypoglycemia. Furthermore, GLP-1 RAs demonstrate beneficial effects on nonglycemic markers such as body weight, lipids, and systolic blood pressure. The enhanced glycemic efficacy of GLP-1 RAs accompanied by the unique nonglycemic effects may facilitate a more "tailored" approach to therapy for many patients with T2DM. © 2011.

Duke Scholars

Author Scott Victor Joy Medicine, General Internal Medicine