Glucagon like peptide 1 (GLP-1) analogues are a relatively new type of treatment called 'incretin mimetics' designed to lower blood glucose in patients with type 2 diabetes.
There are currently 2 type of GLP-1 analogues: Exentide and Liraglutide. Both are administered by subcutaneous (under the skin) injection like insulin using pen devices similar to the ones shown.
The first formulation of Exenatide is administered twice daily but a newer form of this medication has become available in the UK which can be administered once per week. Liraglutide is given once daily.
GLP-1 analogues mimic the effect of a hormone called GLP-1. Exenatide was originally discovered in the saliva of the Gila monster shown in the picture but is now synthesised chemically in a laboratory.
GLP-1 analogues are licensed for treatment of type 2 diabetes in combination with metformin, and/or sulphonylureas in patients who have not achieved adequate glycaemic control on tolerable doses of these oral treatments and are very overweight (BMI 35 kg/m² or higher). More detailed guidance on the use of liraglutide and exenatide are available from the NICE website.
GLP-1 analogues work by stimulating pancreatic beta cells to produce insulin only in response to raised blood sugar. They also reduce the production of a hormone called glucagon, slow the emptying of food from the stomach and reduce appetite, all of which lead to a lowering of blood glucose.
These medications have an advantage over insulin in that they help patients to lose weight whereas insulin usually causes weight gain, which is undesirable in patients who are already overweight.
GLP-1 analogues can cause gastrointestinal side-effects such as nausea, vomiting, heartburn, abdominal pain, bloating and diarrhoea. There have been some very rare reports of a condition called pancreatitis (inflammation of the pancreas) in patients taking exenatide. People taking exenatide should immediately report any severe abdominal pain to a healthcare professional.
These agents should not cause excessively low blood glucose (hypoglycaemia) on their own but may do so when taken in combination with sulphonylureas.
GLP-1 analogues are less likely to cause hypoglycaemia than insulin and the rules governing the holding of driving licenses are therefore less stringent. For further information follow the link on the right hand side of the page.
Guy's and St Thomas' Diabetes Services provide a specialist service for the initiation of GLP-1 analogue therapy.