Prandial glucagon-like peptide-1 receptor agonists in clinical practice

• I.V. Poluboyarinova
• Valentin V. Fadeev

Abstract

Metabolic effects glucagon-like peptide-1 receptor agonists (GLP-1 RA) are the result of glucose-stimulated insulin secretion enhancement, inhibition of glucagon secretion, slowing gastric emptying and increased satiety. These properties indicate that GLP-1 RA may be appointed as treatment option in diabetes mellitus type 2. Despite the fact that different GLP-1 medications have similar basic mechanisms of drug actions, differences in their pharmacokinetic and pharmacodynamic characteristics lead to different effects on glycemic parameters. Therefore, for medication selection optimization it is necessary to understand (in details) GLP-1 RA effects on glucose homeostasis in people with diabetes mellitus type 2. Direct comparisons between long-acting non-prandial and short- acting prandial GLP-1 RA confirm their different effects on fasting plasma glucose (FPG) and postprandial blood glucose (PPG). Evidence suggests that GLP-1 RA mainly targeted on postprandial fluctuations of blood glucose (exenatide twice daily and once-daily prandial lixisenatide) is better to use in combination therapy with basal insulin. In that case they will form a new important opportunity for diabetes mellitus type 2 treatment.

Keywords:glucagon-like peptide-1 receptor agonists, GLP-1 RA, basal insulin, prandial glucose regulation, diabetes mellitus type 2

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