Optimizing outcomes with incretin‐based therapies: Practical information for nurse practitioners to share with patients

PURPOSE: To introduce the role of incretin therapies and suggest strategies for nurse practitioners to implement them in practice. DATA SOURCES: PubMed, Medline, summary of product characteristics/package inserts. CONCLUSIONS: Incretin-based therapies offer a new alternative to currently available agents. They provide adequate levels of glycemic control and are associated with low incidence of hypoglycemia and weight gain. Dipeptidyl peptidase-4 inhibitors, for example sitagliptin, have a modest effect on A1c levels (-0.7%) as monotherapy; however, they reduce A1c to a greater extent when combined with metformin ( approximately 2.0%). Typical starting dose of sitagliptin is 100 mg; dose adjustments are required in subjects with renal complications. Glucagon-like peptide-1 receptor agonists, exenatide and liraglutide, reduce A1c levels (often in excess of 1.5%) and body weight. Exenatide has a starting dose of 5 mug and is not recommended for patients with hepatic impairment or severe/end-stage renal disease. Liraglutide has been found to benefit from a stepwise dose escalation (i.e., 0.6 mg weekly increments) until a 1.8-mg dose is reached. Unlike exenatide, dose adjustments in patients with renal and hepatic complications are not required. IMPLICATIONS FOR PRACTICE: Incretin-based therapies may help to overcome some of the drawbacks of current therapies used to treat type 2 diabetes.