The intersection of safety and adherence: new incretin-based therapies in patients with type 2 diabetes mellitus.

One of the challenges facing health care providers in the treatment of patients with type 2 diabetes mellitus is maintaining the balance between achieving hemoglobin A(1c) targets while simultaneously minimizing adverse events-most notably hypoglycemia and weight gain-that may negatively affect adherence to therapy and thus treatment outcomes. Incretin-based treatments, such as glucagon-like peptide-1 (GLP-1)-receptor agonists and dipeptidyl peptidase-4 (DPP-4) inhibitors, are the newest class of therapies for the management of patients with type 2 diabetes. Data from clinical trials in which liraglutide, exenatide, saxagliptin, or sitagliptin were employed as monotherapy or added to ongoing antidiabetic treatment indicate that the incretin-based therapies have very low risk for the development of hypoglycemia and either decrease body weight (GLP-1-receptor agonists) or are weight neutral (DPP-4 inhibitors). Decreased risk for hypoglycemia and weight gain may improve adherence. Avoiding weight gain, which is commonly associated with older oral antidiabetic agents and some insulins, also has the potential to decrease the risk for cardiovascular disease. Future pharmacoeconomic studies may demonstrate translation of these benefits into good cost-effectiveness for these therapies.