Abstract
Extensive experience from randomized clinical trials demonstrates the efficacy of GLP-1 agonists and DPP-4 inhibitors as monotherapy and in combination with metformin and other agents, although reductions in FPG and PPG, and consequently A1C, are greater with GLP-1 agonists than with DPP-4 inhibitors. This difference may result from the pharmacologic levels of GLP-1 activity that are achieved with the GLP-1 agonists and their direct action on the GLP-1 receptor. The GLP-1 agonists have attributes that would make either of them an appropriate choice in the management of all 3 patients in our case studies, while either DPP-4 inhibitor would be an appropriate choice for Case 1. Differences in dosing, administration, safety, and tolerability should be considered.
MeSH terms
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Adamantane / analogs & derivatives
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Adamantane / therapeutic use
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Aged
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Blood Glucose
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Diabetes Mellitus, Type 2 / drug therapy*
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Diabetes Mellitus, Type 2 / physiopathology*
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Dipeptides / therapeutic use
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Dipeptidyl-Peptidase IV Inhibitors / administration & dosage
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Dipeptidyl-Peptidase IV Inhibitors / therapeutic use*
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Exenatide
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Female
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Glucagon / metabolism
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Glucagon / therapeutic use
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Glucagon-Like Peptide 1 / agonists
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Glucagon-Like Peptide 1 / analogs & derivatives*
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Glucagon-Like Peptide 1 / therapeutic use
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Glucagon-Like Peptide-1 Receptor
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Glycated Hemoglobin / metabolism
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Humans
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Hypoglycemic Agents / administration & dosage
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Hypoglycemic Agents / therapeutic use*
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Incretins / pharmacology*
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Incretins / therapeutic use*
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Insulin / metabolism*
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Insulin Resistance
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Liraglutide
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Male
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Metformin / therapeutic use
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Middle Aged
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Peptides / therapeutic use
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Pyrazines / therapeutic use
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Receptors, Glucagon
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Sitagliptin Phosphate
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Triazoles / therapeutic use
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Venoms / therapeutic use
Substances
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Blood Glucose
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Dipeptides
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Dipeptidyl-Peptidase IV Inhibitors
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GLP1R protein, human
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Glucagon-Like Peptide-1 Receptor
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Glycated Hemoglobin A
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Hypoglycemic Agents
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Incretins
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Insulin
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Peptides
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Pyrazines
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Receptors, Glucagon
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Triazoles
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Venoms
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Liraglutide
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Glucagon-Like Peptide 1
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Glucagon
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Metformin
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saxagliptin
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Exenatide
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Adamantane
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Sitagliptin Phosphate