Optimizing outcomes with incretin-based therapies: Practical information for nurse practitioners to share with patients

Author: Fleury-Milfort, Evelyne

Source: Journal of the American Academy of Nurse Practitioners, Volume 21, Supplement 1, November 2009 , pp. 642-650(9)

Publisher: Wiley-Blackwell

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Abstract:

Purpose:

To introduce the role of incretin therapies and suggest strategies for nurse practitioners to implement them in practice. Data sources:

PubMed, Medline, summary of product characteristics/package inserts. Conclusions:

Incretin-based therapies offer a new alternative to currently available agents. They provide adequate levels of glycemic control and are associated with low incidence of hypoglycemia and weight gain. Dipeptidyl peptidase-4 inhibitors, for example sitagliptin, have a modest effect on A1c levels (−0.7%) as monotherapy; however, they reduce A1c to a greater extent when combined with metformin (∼2.0%). Typical starting dose of sitagliptin is 100 mg; dose adjustments are required in subjects with renal complications. Glucagon-like peptide-1 receptor agonists, exenatide and liraglutide, reduce A1c levels (often in excess of 1.5%) and body weight. Exenatide has a starting dose of 5 μg and is not recommended for patients with hepatic impairment or severe/end-stage renal disease. Liraglutide has been found to benefit from a stepwise dose escalation (i.e., 0.6 mg weekly increments) until a 1.8-mg dose is reached. Unlike exenatide, dose adjustments in patients with renal and hepatic complications are not required. Implications for practice:

Incretin-based therapies may help to overcome some of the drawbacks of current therapies used to treat type 2 diabetes.

Keywords: GLP-1 agonists; DPP-4 inhibitors; drug interactions; special populations

Document Type: Research article

DOI: http://dx.doi.org/10.1111/j.1745-7599.2009.00454.x

Publication date: 2009-11-01