GLP-1 Analogs and Lifestyle Modifications
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Transcript GLP-1 Analogs and Lifestyle Modifications
GLP-1 Analogs and Lifestyle
Modifications
MARGARITA SIANOSYAN, DOCTOR OF PHARMACY
CANDIDATE, LECOM COLLEGE OF PHARMACY
Overview
GLP-1 analog’s role in the body
Available GLP-1 analogs on the market
Advantages over other anti-diabetic agents
Benefits when combined with lifestyle modifications
Importance of healthy diet, physical activity, and
sleep with GLP-1 analogs
Nutrition and physical activity recommendations
GLP-1 in Type 2 Diabetes
Ganda, Om. Diabetes and the GI Tract: Important Interrelationship. Medscape reference. WebMD 2011.
GLP-1 Analogs
Synthetic and structurally-altered version of naturally
produced hormone
Mimic physiological actions of GLP-1
Naturally produced GLP-1 are rapidly inactivated by
(dipeptidyl-peptidase 4) DPP-4 enzyme
Half life is 1-2 minutes
GLP-1 analogs are resistant to inactivation by DPP-4
enzyme and stay longer in the body
Work only in presence of glucose
Dungan K. Glucagon-like peptide-1-based therapies for the treatment of type 2 diabetes mellitus. In: UpToDate, Nathan, DM (Ed), UpToDate, Waltham, MA 2012.
Mechanisms of Action
Glucose-dependent insulin
production
Stimulates beta-cells and
causes insulin secretion
Inhibits glucagon secretion
Delays gastric emptying
Induces satiety and
decreases food intake
Improves beta-cell function
and proliferation (animal
studies)
Conetta C, Patel, M. (2012, February 22). GLP-1 Analogs and DeFronzo's Octet. Diabetes in Control.
Retrieved September 5, 2012, from http://www.diabetesincontrol.com/articles/features/12372
http://www.socbdr.org/e4/e887/volRdsVolumes5237/issRdsIssues5874/chpRdsChapters5886/strRdsArticles5887/
index_en.html?preview=preview&showfulltext=1
Satiety and Food Intake
Long term weight loss
Exact mechanism is unclear
Acts on hypothalamic feeding centers
Conetta C, Patel, M. (2012, February 22). GLP-1 Analogs and
DeFronzo's Octet. Diabetes in Control. Retrieved September 5, 2012,
from http://www.diabetesincontrol.com/articles/features/12372
http://www.funderstanding.com/educators/brain-anatomy/
GLP-1 Analogs on the Market
Used as an adjunct to diet and exercise to improve
glycemic control
Administered by subcutaneous injection
Byetta (Exenatide) – twice daily SQ injection
Victoza (Liraglutide) – once daily SQ injection
Bydureon (extended-release Exenatide) – once
weekly SQ injection
Dungan K. Glucagon-like peptide-1-based therapies for the treatment of type 2 diabetes mellitus. In: UpToDate, Nathan, DM (Ed), UpToDate, Waltham, MA 2012.
Safety Profile
Mild or moderate nausea
Titrating dose may limit nausea
Diarrhea
Headaches
Dizziness
Hypoglycemia when taken with sulfonylureas
Rare cases of acute pancreatitis and renal dysfunction
Exenatide should not be used in patients with
creatinine clearance <30 mL/min
McCulloch DK, Munshi M. Treatment of type 2 diabetes mellitus in the elderly patient. In UptoDate, Nathan DM, Schmader KE (Ed), UpToDate, Waltha, MA.2012.
http://www.uptodate.com/contents/treatment-of-type-2-diabetes-mellitus-in-the-elderly-patient
GLP-1 with other Anti-diabetics
Can be used alone or in
combination with other
anti-diabetic agents
Combination with
dipeptidyl-peptidase-4
(DPP-4) inhibitors is not
recommended and is not
FDA approved
Hester, SA. Pharmacist’s Letter. Combining a GLP-1 Agonist and a DPP-4
Inhibitor for Type 2 Diabetes. Stockton, CA: Therapeutic Research
Faculty; [online] http://www.pharmacistsletter.com. September 5, 2012.
http://www.ehow.com/how_7433049_use-byetta-pen.html
In Comparison to Other Anti-diabetics
Less incidence of
hypoglycemia
Greater reduction in A1C
levels
Weight reduction
Undesirable effects of other
anti-diabetic agents can
lead to non-adherence to
medications
Diabetes Obes Metab. (2012, April 9). GLP-1 a Good Choice for
Glycemic Control?. Diabetes in Control. Retrieved September 5, 2012,
from http://www.diabetesincontrol.com/articles/53-diabetesnews/12658-glp-1-a-good-choice-for-glycemic-control
http://www.freediabetestestsupplies.com/cinnamon-diabetes-naturalcure/
Cardiovascular Health
Primary cause of death in Type 2 Diabetes patients
is cardiovascular disease (CVD)
GLP-1 agonists lower blood pressure and cholesterol
Increased cardiac contractility and protection
against ischemia
Spellman CW. (2010). Pharmacology of GLP-1 Agonists: Describing the Therapeutic Potential to Patients. The Journal of the American Osteopathic Association, 11(2), eS10-eS14. Retrieved
September 5, 2012 from http://www.jaoa.org/content/111/2_suppl_1/eS10.full
http://www.virtua.org/health/cardiovascular-health.aspx
Adjunct to Diet and Weight Control
Works best when
combined with healthy
diet and physical activity
Diet and weight control
Slows progression to Type 2
diabetes
Prevents complications
Conetta C, Patel, M. (2012, February 22). GLP-1 Analogs and DeFronzo's Octet. Diabetes in
Control. Retrieved September 5, 2012, from
http://www.diabetesincontrol.com/articles/features/12372
http://www.northcentraliaredcross.org/wp-content/uploads/2012/03/Healthy-Foods_C.gif
Medical Nutrition Therapy (MNT)
“Nutritional diagnostic, therapy, and counseling
services for the purpose of disease management,
which are furnished by a registered dietitian or
nutrition professional.”
Key component in preventing diabetes, managing
diabetes, and preventing associated complications
Covered by Medicare and many other private and
state insurance plans
American Diabetes Association. Medical Nutrition Therapy: A Key to Diabetes Management and Prevention-2010. Clinical Diabetes. 2010;28:12-18
Medical Nutrition Therapy (MNT)
Current literature supports
MNT as an effective method
for treating diabetes
18 studies reviewed by ADA
8 were randomized controlled trials
Intervention groups had greater
improvements in A1C levels and
fasting plasma glucose
Lifestyle modifications play an
important role in managing
diabetes
American Diabetes Association. Medical Nutrition Therapy: A Key to Diabetes
Management and Prevention-2010. Clinical Diabetes. 2010;28:12-18
http://www.cvmc.org/hospital/departments-services/patient-supportservices/nutrition-diabetes-counseling
Diet
Important to reinforce healthy
diet
Types of foods
Limiting foods high in sugar, salt,
and fat
Frequency
Eating smaller portions throughout
the day
Portion control
Keeping track of carbohydrate intake
American Diabetes Association. Medical Nutrition Therapy: A Key to
Diabetes Management and Prevention-2010. Clinical Diabetes.
2010;28:12-18
http://www.saintshealthymarriages.com/healthy-diet-plans/
Nutrition
Complex carbohydrates
(55%), protein (20%),
healthy fats (25%)
High fiber
carbohydrate foods
Saturated fat intake of
<7% of total calories
Minimal trans fat
intake
American Diabetes Association. Medical Nutrition Therapy: A Key to Diabetes Management and
Prevention-2010. Clinical Diabetes. 2010;28:12-18
http://concordweightloss.com/2011/05/03/downsize-portions-for-better-weight-control/
Physical Activity
At least 150 minutes per
week of moderate-intensity
aerobic physical activity
50-70% of maximum heart rate
Resistance training three
times a week
American Diabetes Association. Medical Nutrition Therapy: A
Key to Diabetes Management and Prevention-2010. Clinical
Diabetes. 2010;28:12-18
http://extrachapter.com/exercise-and-diabetes/
Weight Control
Even small amounts of
weight loss can improve
glycemic control
Changes in BMI can reduce
A1C and blood pressure
Improve lipid levels
Reduce cardiovascular risk
factors
American Diabetes Association. Weight Loss, Glycemic Control, and Changes in
Cardiovascular Biomarkers in Patients With Type 2 Diabetes Receiving Incretin
Therapies or Insulin in a Large Cohort Database-2010. Diabetes Care. 2010;
33:1759-1765.
http://www.askcms.com/weight-loss/natural-weight-loss-supplements/
Sleep
In addition to healthy diet
and exercise, sleep also
has an important role in
weight control
Study found that middleaged, overweight men who
slept 8.5 hours burned
more fat than patients that
slept 5.5 hours
Elevated levels of ghrelin
in the blood
Ann Intern Med. 2010;153:435-441, 475-476
www.adultspancounseling.com/wp-content/uploads/2008/04/ManSleeping.jpg
Conclusion
GLP-1 analogs have several mechanisms of action in
the body.
GLP-1 analogs’ advantages over other anti-diabetic
agents include less hypoglycemia, better A1C control,
no weight gain, and cardioprotection.
GLP-1 analog therapy is used as an adjunct to healthy
diet and exercise.
Healthy lifestyle modifications are necessary for
successful treatment.