Differentiating among incretin-based therapies in the management of patients with type 2 diabetes mellitus

Table 1 Comparison of GLP-1R agonists and DPP-4 inhibitors.

	GLP-1R Agonists	DPP-4 Inhibitors
Agents currently available in U.S. with dosing information (normal renal function)[31–35]	• Exenatide 5-10 mcg SC BID • Liraglutide 1.2-1.8 mg QD	• Sitagliptin 100 mg PO QD • Saxagliptin 2.5-5 mg PO QD • Linagliptin 5 mg PO QD
Benefits
Reduction in A1C level*[22–24, 26, 29, 36–45]	0.5%-1.5%	0.5%-0.9%
Reduction in fasting plasma glucose*[29, 39–41, 49–51]	↓7 to 74 mg/dL	↓11 to 29 mg/dL
Reduction in postprandial glucose*[9, 27, 51, 54, 55]	↓41 to 47 mg/dL	↓49 to 68 mg/dL
Weight effect [14, 22, 24, 26, 29, 37, 39–41, 44, 45, 49, 50, 52, 60]	↓1-4 kg	↓0.9 to ↑1.4 kg
Effect on triglycerides [24, 29, 36, 37, 39, 41, 49, 60, 62]	↓12-40 mg/dL	↑16 mg/dL to ↓35 mg/dL
Reduction in systolic blood pressure [13, 14, 24, 29, 36, 37, 39, 41, 49, 60, 62]	↓1-7 mm Hg	0 to ↓3.9 mm Hg
May improve markers of pancreatic β-cell function (such as homeostasis model assessment-β-cell function, fasting insulin, fasting proinsulin to insulin ratio, fasting C-peptide)[8, 13, 22–24, 26, 30]	✓	✓
Disadvantages
Incidence of mild/moderate hypoglycemia**[9, 10, 24, 26, 36–39, 41, 43–45, 52, 55, 64]	0%-12%	0%-4%
Nausea [13, 33–35]	26%-28%	0-1%
Hypersensitivity reactions [33–35]	Rare (exenatide)	✓
Antibody formation [31–35, 79, 80]	30-67% E; 8% L	NR

*As monotherapy or as add-on therapy.
**Generally included asymptomatic hypoglycemia or symptomatic hypoglycemia with blood glucose < 55 mg/dL not requiring third-party assistance.
BID, twice daily; NR, not reported; PO, orally; QD, once daily; SC, subcutaneously

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