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Incretin hormones have recently been recognised in playing an important role in the pathogenesis and treatment of type 2 diabetes.1 Of these, glucagon-like peptide (GLP-1) is probably the most important but has a limitation due to its rapid breakdown by the enzyme dipeptidyl peptidase 4 (DPP-4) giving it a half life in circulation of approximately 2 min.
To overcome this limitation, two pharmacological approaches have been developed: (1) DPP-4 inhibitors (sitagliptin, saxagliptin) that increase the endogenous concentrations of GLP-1 through inhibition of DPP-4 and (2) GLP-1 mimetics (exenantide) or analogues (liraglutide). The former have the advantage of being taken orally whereas the latter are injectable. Previous studies have all focused on comparing incretin-based treatments to other medications such as sulphonylureas, metformin, thiazolidinediones or insulin.2 3 There are very few studies comparing one form of incretin therapy to …
Competing interests VF has received consultancy fees, lecture fees and grants from Glaxo Smith Kline, Novartis, Novo-Nordisk, Takeda, Astra-Zeneca, Sanofi-Aventis, Eli Lilly, Daiichi-Sankyo, Novartis, NIH, ADA. CD has received consultancy fees from Novo Nordisk and Takeda. ANK is an investigator in the TECOS trial funded by Merck.