I attended a fantastic webinar earlier today courtesy of Novo Nordisk.
The session focused on the management of Type II Diabetes within the clinical setting and considered the more ‘recently’ released medicines to facilitate effective glycaemic control, namely:
SGLT2 Inhibitors - E.g. Canagliflozin
DPP4 Inhibitors - E.g. Alogliptin and Sitagliptin
GLP-1 Agonists - E.g. Dulaglutide and Semaglutide
These antidiabetic agents aim to build on / replace the more traditional drugs within this therapeutic space.
The SGLT2 inhibitors work by reducing glucose reabsorption in the kidney. This is achieved by blocking the SGLT2 channel, which allows for sugars to be passed out in the urine. Consequently, there is a low risk of hypoglycaemia from this treatment modality alongside the positive benefit of weight loss due to removal of excess calories from the body. By promoting the effective removal of sugars from the systemic circulation, these agents have a secondary positive impact in that they reduce blood pressure (i.e. an action similar to commonly prescribed diuretics). Hence, this class of drug is regarded as being ‘renoprotective’. One negative aspect to consider is the potential for urinary tract infections due to the increased concentration of sugar in the urine. Should this issue present on any large scale then ‘sick day rules’ would apply and the patient would be advised to temporarily stop the medicine until back to normal.
The incretin-based therapies (i.e. DPP4 inhibitors and GLP-1 agonists) centre around the response of the body following the ingestion of food. In this case, when the patient eats food the body releases glucagon-like peptide 1 (i.e. GLP-1), which stimulates receptors across the stomach, hypothalamus and pancreas. The response to such stimulation includes decreased appetite, reduced gastric emptying, increased insulin release and decreased glucagon release. As such, the DPP4 inhibitors aim to prevent the breakdown of natural GLP-1 and thereby promote normal biological effects (i.e. by increasing exposure of GLP-1 in the body). A similar outcome is noted in the case of GLP-1 agonists, where the availability of the agent following administration in essence brings about those actions associated with endogenous GLP-1. Both classes of drug are glucose independent and thus avoid the issue of hypoglycaemia. In addition, as a whole this therapeutic approach is beneficial for patient weight (i.e. ‘weight neutral’ for DPP4 inhibitors and the advantage of weight loss for GLP-1 agonists). Overall, these drugs are generally well tolerated but may have transient adverse gastrointestinal effects; however, these generally subside with time which is reassuring for the patient.
More information about T2DM management may be located in the ADA/EASD Guidelines.
The webinar was excellent. It really helped me to understand current modalities for diabetes management. So, I would like to extend my thanks to Novo Nordisk for this.
