Incorporating New Therapy Into Established Clinical Practice Guidelines

Authors: James M. Wooten, PharmD


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.2,3

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