Individualised incretin-based treatment for type 2 diabetes

摘要

Type 2 diabetes is treated by a stepwise approach, starting with lifestyle changes at early stages (enforced by structured education for patients), combined with one or several glucose-lowering agents. Because of the progressive nature of the disease, an increasing number of glucose-lowering drugs have to be used with advancing diabetes duration. In The Lancet today, Richard Bergenstal and colleagues report the results of DURATION-2, comparing exenatide once weekly with either sitagliptin (an inhibitor of dipeptidyl peptidase-4) or pioglitazone (athiazolidinedione), and Michaela Diamant and colleagues report the results of DURATION-3, comparing exenatide once weekly with insulin glargine titrated to predefined fasting glucose targets. Exenatide once weekly was superior for reduction of glycosylated haemoglobin (HbA_(lc)) compared with all other agents, and did not cause hypoglycaemic episodes. Treatment with exenatide once weekly also led to substantial weight loss, which was, as anticipated, different to the results achieved with pioglitazone and insulin glargine treatment, both of which were associated with weight gain.