Nutrition Strategies for Patients on New Incretin Therapies for Type 2 Diabetes

Abstract

or 9.3% of the population (www.diabetes.org/diabetes-basis/ statistics). Medications for the treatment of type 2 diabetes targeting incretin hormones for improved glycemic control have emerged as favorable second-line additions to metformin and lifestyle changes. In this article, we discuss the benefits of using glucagon-like peptide 1 receptor agonist medications and dipeptidyl peptidase 4 inhibitors along with their implications for weight and dietary management of type 2 diabetes. Nutr Today. 2014;49(5):254Y261 D iabetes is a complex metabolic disease that has a multifactorial pathogenesis and affects about 9% of the American population. 1 The 8 organs and systems involved in this pathogenesis, as proposed by DeFronzo 2,3 include increased glucose release from the liver, decreased glucose uptake by muscles, decreased insulin secretion by pancreatic A cells, accelerated lipolysis of fat cells, incretin deficiency/resistance in the gastrointestinal tract, hyperglucagonemia by pancreatic > cells, increased glucose reabsorption in the kidney, and loss of insulin-induced appetite suppression in the brain. This understanding of the many effects of diabetes on different areas of the body has led to the development of 12 different medication classes to treat this disease, including glucagon-like peptide 1 agonist (GLP-1 agonist) medications and dipeptidyl peptidase 4 (DPP-4) inhibitors. 4Y6 These provide the team delivering diabetes care many options for customizing therapy for individual patients for improved glucose control as well as reduced morbidity and mortality. In this article, we review a case from our family medicine clinic of an adult patient with new-onset type 2 diabetes mellitus (T2DM) who resisted treatment with metformin (Glucophage; Bristol-Myers Squibb [Princeton, New Jersey]) combined with insulin, as recommended in the 2014 American Diabetes Association (ADA) Standards of Medical Care in Diabetes. 7 Although this patient was willing to take metformin, he adamantly voiced concerns about some of the adverse effects of taking insulin, especially weight gain and hypoglycemia. He expressed interest in trying newer therapies he heard from a friend and also advertised on television as promoting blood glucose control without weight gain. We highlight how GLP-1 agonists and DPP-4 inhibitors work and implications of treatment with practical considerations such as effects on weight, timing of meals, and moderating adverse effects. 4Y6 We highlight how GLP-1 agonists and DPP-4 inhibitors work and implications of treatment with practical considerations such as effects on weight, timing of meals, and moderating adverse effects.We also comment on cost and safety concerns related to effects of use on the pancreas and thyroid. CASEVisit With Physician Assistant. B.L. is a 42-year-old man who presented to the physician assistant at his primary care doctor's office to be checked for diabetes because his wife noticed his excessive thirst. He denied increased appetite and says that his urinary frequency is about wha...