Optimizing diabetes treatment in the presence of obesity

Article Figures & Data

TABLE 1

Sites of action and physiologic effects of glucagon-like peptide-1

Site of action	Physiologic effects	Remarks
Pancreas	Stimulates insulin secretion Inhibits glucagon secretion	These actions are glucose-dependent
Vagal afferent neurons	Slows gastric emptying Decreases gastric acid secretion Stimulates pancreatic insulin secretion	Effects mediated via vagal signaling to the gastrointestinal tract and the pancreas
Central nervous system	Suppresses appetite and reduces food intake	Satiety and reward centers of the brain

TABLE 2

Currently approved glucagon-like peptide-1 receptor agonists for diabetes mellitus

Generic name (Brand name)	Administration^a	Dose	Hemoglobin A1creduction (%)	Weight change (kg)
Exenatide BID (Byetta)⁹	Within 60 minutes before breakfast and dinner	5 μg BID	0.5 to 0.7	–1.1 to –2.7
Exenatide BID (Byetta)⁹	Within 60 minutes before breakfast and dinner	10 μg BID	0.7 to –1.7	–1.5 to –2.9
Liraglutide (Victoza)¹⁰	Once daily at any time of day	0.6 mg QD
		1.2 mg QD	0.8 to 1.1	+0.3 to –2.6
		1.8 mg QD	0.5 to 1.5	–0.2 to –2.8
Exenatide QW (Bydureon)¹¹	Once every 7 days at any time of day	2 mg QW	1.3 to 1.6	–2.0 to –2.7
Albiglutide (Tanzeum)¹²	Once every 7 days at any time of day	30 mg QW	0.7 to 0.8	–0.4 to –1.2
Albiglutide (Tanzeum)¹²	Once every 7 days at any time of day	50 mg QW	0.6 to 0.9
Dulaglutide (Trulicity)¹³	Once weekly at any time of day	0.75 mg QW	0.7 to 1.6	+0.2 to –2.8
Dulaglutide (Trulicity)¹³	Once weekly at any time of day	1.5 mg QW	0.8 to 1.6	–0.9 to –3.1
Lixisenatide (Adlyxin)¹⁴	Within 60 minutes before main meal	10 μg QD	0.6 to 0.9	+0.31 to –2.7
Lixisenatide (Adlyxin)¹⁴	Within 60 minutes before main meal	20 μg QD