The incretin effect and its role on type 2 diabetes mellitus
Main Article Content
Keywords
Incretins, Diabetes, Insuline, Glucose
Abstract
In the gastrointestinal tract we produce hormones, called incretins, in response to food ingestion with a direct effect on pancreatic β and α cell, improving the insulin and glucagon response to glucose. The main incretins are: glucagon like peptide-1 (GLP1) and glucose-dependent insulinotropic peptide (GIP).
The "incretin effect” consists in a greater secretion of insulin by the pancreas when the glucose stimulus is gastrointestinal rather when it is intravenous. In type 2 diabetics, the incretin effect is altered and can be improved by elaboration of a GLP1 resistant to the action of DPP4 (GLP1 analogs) or by direct inhibition of the enzyme that deactivates incretines by means of DPP4 suppressor. There are two analogous of GLP1, exenatide and liraglutide and some others still in research. Three inhibitors of DPP4: sitagliptin, vildagliptin and saxagliptin produce a prolonged inhibition of DPP4 and as a consequence increased effect of native incretins with better control of fasting and postprandial glucose and improve on A1c with a very few hypoglycemic events and without weight-loss in patients.
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