SGLT-2 INHIBITORS AND INCRETIN BASED THERAPIES IN THE TREATMENT OF TYPE 2 DIABETES MELLITUS

Abstract

Incretin based therapies include the dipeptidyl peptidase 4 inhibitors (DPP4i) and the glucagon-like peptide 1 receptor agonists (GLP-1 RA). Oral DPP4i are approved for use in India. DPP4i can be used as monotherapy or in combination with other oral agents or with basal insulin. They are weight neutral and have a low risk of hypoglycaemia. GLP-1 RA are either analogs of human GLP-1 (liraglutide, dulaglutide, albiglutide) or are based on the exendin molecule (exenatide, lexisenatide). Clinical trials have shown that the GLP-1 RA effectively lower the blood glucose levels when used as a monotherapy or in combination with other drugs. Under physiologic conditions, SGLT-2 transporter in the renal proximal tubule reabsorbs 80-90% of the filtered glucose. SGLT-2 is primarily expressed in the kidney, but is also found in the α-cells. The latest National Institute for Health and Care Excellence (NICE) Guidelines recommend the use of metformin as the initial choice of therapy and a target HbA1c of <6.5% most patients.