When anyone receives a diagnosis of diabetes it will be obvious that the main aim of treatment is to lower blood glucose. There are various drug targets for this purpose and different ways to achieve the same aim.

Drugs such as acarbose (glucobay) reduce the absorption of glucose from the intestine into the blood. The medication group known as sulphonylureas such as gliclazide (diamicron) and the glinides, for example repaglinide (novonorm), help the pancreas release more insulin and thereby reduce blood sugar that way. Reducing the liver’s own production of glucose with metformin (glucophage) or making the body much more sensitive to the action of your own insulin with pioglitazone (actos) are other ways of achieving this objective.

We have recently added a new and novel way of lowering blood glucose to our armoury. This is based on encouraging the kidney to excrete glucose by way of taking the drug dapagliflozin (forxiga). This drug lowers blood glucose because it stops the kidney conserving glucose inside the body and you end up losing large amounts of glucose in the urine.

An entirely different class of medication based on the physiological action of a gut hormone called glucagon-like peptide (GLP-1) is the subject of this review. These are the so-called Incretin hormone based therapies. They rely on their ability to regulate a number of different natural processes the combination of which act in unison to lower blood glucose. By influencing the way the stomach delivers food to the intestine, by increasing pancreatic insulin supply, increasing the body’s sensitivity to insulin and by reducing the manufacture of sugar from the liver, the net result is to lower blood glucose and improve diabetes control.

As there is such a wide selection of possible drugs to use in diabetes treatment patients have typically tried many different variations and combinations. No single diabetes treatment would be considered best or most appropriate for everyone. In fact what works for one person may not work so well for another.

The choice of drug depends on a variety of physiological factors and the selection of the best drug for each patient never follows the theory that one size fits all. In Type 2 diabetes metformin (glucophage) is considered the mainstay of treatment but it is not used when there is significant kidney impairment. Other treatments such as Incretin based therapies can be used on their own or added to glucophage.

However, for each of the possible drug classes there is always the question of the relative benefits versus possible drug side effects. In this article we explore the concept of risk versus benefit by discussing the controversial news claims relating to Incretin based therapies.

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