Vladimír Uličiansky, Zbynek Schroner
The increasing incidence and prevalence, variable pathogenesis, progressively worsening natural history and complications of type 2 diabetes mellitus emphasise need for new treatment strategies. Long-acting agonists of glucagon-like -peptide-1 receptor improve prandial insulin secretion, reduce excessive glucagon production and promote satiety. In the case of exenatide QW the microsphere delivery system provides continuous therapeutic levels of exenatide. Exenatide QW in clinical studies DURATION demonstrated better glycaemic control compared with exenatide BID, sitagliptin, pioglitazone, and insulin glargine titrated to target. In comparison with liraglutid 1.8 mg the effect was slightly lower, but with lower proportion of patients reporting nausea. GLP-1 agonists are involved in clinical algorithms of international and national diabetic associations as the second or third-line therapy in dual therapy regimens (in combination with metformin or a sulphonylurea or a thiazolidindione) or in triple therapy regimens (in combination with metformin and sulphonylurea, or metformin and thiazolidindione).