Incretin Based Treatments

Sitagliptin (Januvia®)

Sitagliptin is an oral medicine for people with type 2 diabetes that helps control blood sugar levels after eating. It is a medicine that slows the breakdown of your natural GLP-1 by slowing its breakdown by the enzyme DPP-4. It is called a DPP-4 inhibitor.

Sitagliptin is approved by the Food and Drug Administration (FDA) for combined use with metformin, insulin releasing pills and thiazolidinediones.

In short, sitagliptin lowers glucagon during a meal, and increases insulin release from the pancreas when the blood sugar is too high.

The most common side effects are:

• Sore throat
• Runny nose
• Upper respiratory infections
• Low blood sugar, when taken together with insulin releasing pills and insulin

Uncommon side effect:

• Hypersensitivity reactions including allergic reactions, mouth and throat swelling and skin rashes

Contact your medical provider right away if you have side effects.

Ask your medical provider for specific medication and insulin dose adjustment recommendations to avoid low blood sugars. Unlike exenatide, people do not typically lose weight with DPP-4 inhibitors, but fortunately they don’t cause weight gain.

Exenatide (Byetta)

Exenatide is an injected medicine for people with type 2 diabetes that helps prevent the blood sugar from rising after eating. Exenatide acts like a natural hormone, GLP-1, that is released in the gut when we eat. When you have type 2 diabetes, GLP-1 doesn’t work on the pancreas properly. GLP-1 normally is broken down very quickly in the bloodstream by enzymes known as DPP-4. Exenatide was developed to resist breakdown by the enzyme DPP-4. This way exenatide lasts longer in the blood stream and the GLP-1-like action lasts longer. Exenatide is approved by the Food and Drug Administration (FDA) for use in combination with metformin, thiazolidinediones and insulin secretagogues.

In short, exenatide lowers glucagon during a meal, slows food emptying from the stomach, curbs appetite and increases insulin release from the pancreas when the blood sugar is too high.

The most common side effects when starting exenatide are:

• Nausea
• Vomiting
• Low blood sugars

Uncommon side effect:

• May cause pancreatitis

If you experience any side effects, contact your medical provider immediately.

Give your body a chance to adjust to this new medicine slowly. The starting dose is 5 micrograms twice daily, taken at breakfast and dinner. After 1 month, if you are tolerating exenatide, the dose may be increased to 10 micrograms, twice daily. It is available in a disposable pen device.

If you are treated with insulin releasing pills and starting exenatide, it is important to remember:

• Reduce the insulin releasing pill dose by half. Ask your medical provider for exact recommendation.
• Inject exenatide up to 1 hour before eating; it is taken at breakfast and dinner.
• Exenatide is not yet approved by the FDA for use in insulin treated individuals. However, if you are taking exenatide in combination with insulin therapy, the insulin dose should be decreased. Ask your provider for specific recommendations regarding the insulin dose adjustment.
• Some people can lose a small amount of weight while taking exenatide.

For more information about incretin therapy formulations, initial and final doses, and side effects, see our Medications Table.