The newest class of antidiabeteic medications to be approved for use in the United States is the glucagon-like- peptide-1 agonists (GLP-1). There are two drugs in this class that are currently available, exenatide (Byetta, Bydurian) and liraglutide (Victoza) (LexiComp, 2014). These medications mimic the actions of endogenous GLP-1. Endogenous GLP-1 is secreted from the L-cells in the colon and ileum in response to the ingestion of nutrients (Ryan, Foster, & Jobe, 2011, p. 794). GLP-1 has a half-life of 2 minutes due to the action of the DPP-4 enzymes. GLP-1 agonists overcome this issue by having an altered structure that renders them less susceptible to DPP-4 enzymatic degradation thus prolonging the effects of GLP-1 (ADA, 2014, p. 621).
The first glucagon-like peptide 1 agonist to be developed was exenatide. Exenatide was approved for use in the United States in 2005. It is a synthetic form of a molecule exendin-4. Interestingly, this compound was discovered in the saliva of the Gila monster, a reptile found in the desert southwest of North America. This compound was found to be 53% identical to human GLP-1 and mimics GLP-1 on human receptors with a greater stability than native human GLP-1 hormone. (Furman, 2012, p. 464)
In January of 2010, the Food and Drug Administration approved liraglutide for use in the treatment of type 2 diabetes in the United States. Liraglutide is a synthetic form of the human GLP-1 hormone that has been altered in its molecular structure. The alterations increase aggregation of the drug, decreases the binding to albumin, and is more resistant to degradation by DPP-4 enzymes (Ryan et al., 2011, p. 795). These properties increase the bioava...
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... 2 Diabetes Mellitus. Case Reports in Pediatrics, 2013. Retrieved from http://www.hindawi.com/journals/cripe/2013/703925/
Novo Nordisk Inc. (2013). Victoza liraglutide (rDNA origin) injection. Retrieved from http://www.novo-pi.com/victoza.pdf
Robinson, M., & Wynne, A. L. (2012). Drugs affecting the endocrine system. In Pharmacotherapeutics for nurse practitioner prescribers (3rd ed., pp. 587-644). Philadelphia, Pa: F.A. Davis.
Ryan, G. J., Foster, K. T., & Jobe, L. J. (2011). Review of the therapeutic uses of liraglutide. Clinical Therapeutics, 33(7), 793-811.
Tierney, K. (2012). Therapeutic choices, and the nurse practitioner’s role, in type 2 diabetes when metformin is no longer enough. Journal of the American Academy of Nurse Practitioners, 24, 234-248.
VictozaPro.com. (2014). http://www.victozapro.com/practical-resources/access-and-affordability.html
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