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GLP-1 Receptor Antagonist Therapy in Type 2 Diabetes

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In this segment, Julio Rosenstock, MD; Peter Salgo, MD; and Carol Wysham, MD, review the differences between short- and long-acting glucagon-like-peptide 1 receptor antagonists in type 2 diabetes mellitus.

There are actually a to true combination that has been just they accepted approved by the fda recently one is the combination of insulin glargine and exenatide which is a glp-1 or degla deck which is a basal insulin and irregular type and so they were approval specifically they were approved with a little bit difference in how you titrate the degla deck with

Liraglutide is once a week the other is twice a week but it doesn’t matter i mean you can do it once a day one unit or one unit every week or two units every week as long as they do it systematically and the other thing which never makes sense to me is that we have given the glp-1 spawn a fixed dose boom this dose and so on but this is a peptide this is a hormone

And we just used that titrating slowly and gradually so that you use as as much as you need and as you turn a rate like you you would do without every paper i’m doing now with radlett i’d four years no time yeah but only three dosages nope no you cope you turn to say nope ii was saying nope but look systemic type but i’m glad you pronounced it first the fda was

Approved working on the approval and there was a get goal clinical program right what was that all about so the get go program was actually the combination looks a senate it–and and glargine insulin lexus inside itself is a glp-1 receptor agonist is what we call a short-acting gop one receptor agonist which means that you take it within an hour of a meal it

Works at peaks around the time of the peak of the meal absorption and then lasts for about six to eight hours and its advantages is that it has a profound effect on delaying the release of the nutrients into the intestine okay so that the insulin secretion which in type 2 diabetes is delayed and slowed has a better chance of matching that so this short acting

Whether it’s exenatide or it’s lexus senate i’d just latins out the postprandial curve much like i mean better better than rapid-acting insulin so it is a it is a good medication for particularly addressing those people that have big postprandial that’s fine does that make it a different drug from the other glp-1 receptor well it’s a difference because this is

A short-acting there are two sure act in the eggs in a tight and lexus sanitized exenatide is given twice a day lexy sanitized given once a day liraglutide is are much longer acting and then you have dual aglow tied in al big low tide there are once weekly the one that long-acting have some tachyphylaxis in terms of the effect on the gastric emptying they don’t

Have much of a factor of a gastric effect they have a little bit of postprandial effect predominantly have an effect on the fasting and at the blood sugar comes down and the fasting has a carryover effect throughout the day lexy senator is your acting so you give it before breakfast boom they flatten the d postprandial at breakfast and has some carryover effect

We happen after lunch why after lunch maybe because since as carol said no nutrient no nutrient exposure to the beta cell there is no insulin secretion the beta cell pro gets recharged in acts after the after lunch and so on so it’s very specific in the in the in the in the post prandial effect

Transcribed from video
GLP-1 Receptor Antagonist Therapy in Type 2 Diabetes By HCPLive