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Should the class of Incretin Mimetics be considered as a first line therapy for type 2 Diabetes???
matt_1981 posted:
I am a 31 year old Diabetic patient. I have been diabetic since age 22. I have a very complex case and severe insulin resistance, Fatty Liver or NAFLD (NASH) and sever hypertension that requires 4 meds to control. I also have high lipids. All are currently under control but requires an extreme amount of medication.

I started to use the Incretin Mimetic drug Victoza in 2011. This class of drug is an injectable and includes Victoza, Byetta and the newer, 1x weekly version Bydureon. These drugs are quite unique. They offer the benefit of helping with elevated liver enzymes, have shown evidence of improving kidney function including very early onset kidney disease markers such as Microalbuminuria. They also are one of the only drugs for type 2 diabetics that doesn't only NOT cause weight gain but can in some cases promote weight loss. Generally, they do not induce hypoglycemia. So what else do they do? How do they work? Well, they have some impact on insulin resistance although not it's strongest charesteristic. It helps to prevent uptake of glucagon within the liver which leads to less sugar being released by the liver which also leads to improving liver function tests in those individuals that have elevated liver enzymes or fatty liver disease. They also, similarly to the DPP-4 inhibitors (Januvia, Onglyza) help your pancreas make and release more insulin when a detection in elevated sugars takes place. Some people have also reported improvements in blood pressure control and lipid management. While some of the positive aspects of these drugs are not directly related to their indication for prescribing or mechanism of action they are the kind of so called "side effects" that are very good for diabetics! Furthermore, imaging studies have found that while improving liver function tests that it also improves liver histology. When the liver is fatty, or inflamed it is also enlarged. When uncontrolled or with poor glycemic control this can lead to fibrosis (scarring) and eventually cirrhosis. More and more liver transplants are being performed for individuals with Fatty liver or NASH (Non-Alcoholic Steato-hepatitis) which is an advanced form of fatty liver where there is not just fat around the liver but the liver is inflamed and there can be some scarring. This can eventually can get to a point where it is irreversible creating a need for transplant. This class of drugs, specifically the newest drug Bydureon and Victoza have shown to be extremely beneficial at reversing and slowing this process. But thats not all! There is evidence that these drugs also promote the preservation and re-generation of Pancreatic Beta Cells! In type 2 diabetes the pancreas is overworked due to the effects on our bodies metabolism and insulin resistance related to type 2 diabetes. Most diabetes drugs try to compensate for type 2 diabetics by increasing insulin production vs. treating the real problem which is insulin resistance. Preserving Beta Cell function, which are the cells in our pancreas that make insulin is crucial to avoiding the need for insulin down the road as insulin production decreases over time. The only class of drugs designated as true insulin sensitizers is known as TZD's. These include Actos and Avandia. As most of you reading this may already know both of these drugs have been linked with very severe side effects and class action law suits. Avandia is almost never prescribed anymore and Actos as a last resort for most as well. Actos specifically, is great for doing all the things that the incretin mimetics can do but also targets insulin resistance. But the price to pay is weight gain (Typically 10-30 lbs.) bone and joint pain which can lead to fractures and bone density problems as well as the link to bladder cancer. I happen to be an individual that has no choice but to take Actos. I also take Bydureon and Lantus currently. So, while Metformin is typically the drug of choice for newly diagnosed

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