Editorial
Incorporating New Therapy Into Established Clinical Practice Guidelines
Abstract
In this issue of the Southern Medical Journal, McFarland et al have published a quite interesting article entitled "Place in Therapy for Liraglutide and Saxagliptin for Type 2 Diabetes."1 The authors describe and discuss the pharmacology and the utilization for these unique anti-diabetic drugs. Liraglutide, like exenatide, is a glucagon-like peptide-1 (GLP-1) receptor agonist that lowers blood sugar by potentiating glucose-mediated insulin production and reducing glucagon secretion. Normally, the secretion of the human incretin hormone GLP-1 is induced by the presence of nutrients like carbohydrates, proteins, and lipids, but these GLP-1 analogues can be used to stimulate insulin secretion by binding to the GLP-1 receptor. Saxagliptine acts by a related but different mechanism from liraglutide. Saxagliptine inhibits the enzyme dipeptidyl peptidase-4 (DPP-4), which is responsible for metabolizing the human incretin hormone GLP-1. Human incretin hormone GLP-1 normally has a half-life of less than two minutes, but in the presence of saxagliptine the GLP-1 half-life is significantly extended, thus allowing for greater stimulation of the pancreas to secrete insulin.2,3This content is limited to qualifying members.
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References
1. McFarland MS, Brock M, Ryals C. Place in therapy for liraglutide and saxagliptin for type 2 diabetes. South Med J 2011;104:426-439.
2. Zinman B. Initial combination therapy for type 2 diabetes mellitus: is it ready for prime time? Am J Med 2011;124:S19-S34.
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8. Institute for Clinical Systems Improvement (ICSI). Diagnosis and Management of Type 2 Diabetes Mellitus in Adults. 14th ed. January 2010. Available at: http://www.icsi.org/diabetes_mellitus__type_2/management_of_type_2_diabetes_mellitus__9.html. Accessed February 2011.
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