What are the newer hypoglycemic agents ?

The newer hypoglycemic agents act based on Incretin effect.Incretins are neuroendocrine substances that are released from GIT and increases the intestinal absorption of glucose and insulin release from pancreas.

They are of  two types

Glucagon like peptide 1(GLP1) that is degraded by dpp 

Glucose dependant insulinotropic peptide

GLP

GLP increases the glucose dependant insulin secretion only when the blood glucose >70  so, hypoglycemia not a problem with these agents.Following are the mechanism of actions of GLP

There are incretin mimetics and incretin enhancers

Incretin mimetics 

Incretin mimeters are degradation resistant GLP 1 R agonist

EXENATIDE

LIRAGLUTIDE

They can be given through S/C injection

Incretin enhancers

The incretin enhancers act by inhibiting DPP-4 activity

SITAGLIPTIN

VILDAGLIPTIN

They are available as oral preparations

Advantages of these newer incretin based therapy are 

This is associated with decreased risk of hypoglycemia

They help in B cell restoration upto 30%

Cytoprotective effect is also observed 

Helps to reduce weight .

Lipid friendly action is seen with incretin based therapy

They are able to combat the post prandial hyperglycemia that is produced by glucagon

Adverse effects Exenatide are 

Pancreatitis,

Anorexia,

Vomiting

Role of Amyelin in treatment of diabetes

Amyelin is a β cells product to supress α cells

Hence Synthetic amylin analogues are used to decreases α action 

These agents help to lower the postprandial hyperglycemia

Amyelin exerts centrally mediated anorectic action

This can be used as an adjuvant to insulin/SU/Metformin 

PRAMLINTIDE