Incretin manipulation in diabetes management

Table 1 Plasma half-lives, dosage range, average hemoglobin A1c and body weight reduction, and common side effects of glucagon-like peptide-1 analogues

Drug	Plasma ½ -life	Dosage	HbA1c reduction	Weight reduction	Adverse effects	Other special features
Exenatide	3-4 h	5-10 mcg twice daily s.c, 60 min prior to meal	0.68%-0.99%	0.56-1.24 kg	Nausea, diarrhoea, headache, pancreatitis, injection site nodule/reaction, formation of anti-exenatide antibody	Not recommended if Creatinine clearance is < 30 mL/min
Exenatide ER	2 wk	2 mg s.c once weekly	0.99%	1.24 kg	Nausea, diarrhoea, vomiting, pancreatitis, injection site nodule/reaction	Injection at any time independent of meals
Liraglutide	13 h	0.6-1.8 mg s.c once daily	1.01%- 1.18%	2.1-2.5 kg	Nausea, diarrhoea, headache, pancreatitis, injection site reaction, formation of anti-liraglutide antibody and naso-pharyngitis	Store in refrigerator (36-46 0 F)
						Injection at any time independent of meals
Lixisenatide	3 h	20 mcg, once daily s.c	0.90%	3.62 kg	Nausea, diarrhoea, vomiting, pancreatitis
Albiglutide	5 d	30-50 mg s.c once weekly	0.55%- 0.9%	1.21 kg	Upper respiratory infection, diarrhoea, injection site reaction, hypersensitivity, pancreatitis	Administer on the same day of the week
Dulaglutide	4 d	0.75-1.5 mg s.c once weekly	0.99%- 1.3%	-	Nausea, diarrhoea, vomiting, increased amylase and lipase levels, abdominal pain, injection site reaction, hyper-sensitivity and pancreatitis

HbA1c: Hemoglobin A1c.

Table 2 Plasma half-lives, dosage ranges, average hemoglobin A1c reduction and common side effects of dipeptidyl peptidase-4 inhibitors

Drug	Plasma half-life	Dose	HbA1c reduction	Adverse effects	Other remarks
Sitagliptin	12.4 h	100 mg PO daily	0.94%	Nasopharyngitis, diarrhea, headache, constipation, oedema, hypersensitivity, pancreatitis, elevation of hepatic enzymes	Use with caution in renal, hepatic or cardiac failure
Vildagliptin	90 mts - by terminal elimination	50-100 mg/daily PO	0.5%-1%	Headache, nasopharyngitis, cough, constipation, dizziness, and increased sweating
Saxagliptin	2.5 h	2.5-5 mg/PO daily	0.8%	Urinary and upper respiratory infections, headache, edema, purpuric rash, hypersensitivity, pancreatitis and angio-edema	Dose reduction with CYP450 3A4/5 inhibitors
Linagliptin	12 h	5 mg PO daily	0.6%-0.8%	Nasopharyngitis, dyslipidemia, pancreatitis
Teneligliptin	24.2 h	20-40 mg PO daily	0.78%	Constipation, QT interval prolongation, hypoglycaemia and elevation of alanine aminotransferase and γ-glutamyltransferas
Alogliptin	21 h	25 mg PO daily	0.6%	Hypoglycemia, nasopharyngitis, headache and pancreatitis	Monitor LFT and stop if elevated
Anagliptin	4.37 h - by terminal elimination	100 mg PO daily	0.85%	Not available

HbA1c: Hemoglobin A1c.