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''glucagon-like peptide-1 (GLP-1)'' released by small intestine in response to oral glucose load
mediates //incretin effect// oral glc results in greater release of insulin than IV
can inc GLP-1 by either giving analogue or inhibiting breakdown (dipeptidyl peptidase 4 inhibitor)

''GLP-1 mimetics'' - exenatide
increase insulin secretion and inhibit glucagon secretion
licensed for use in T2DM
sub-cut <1hr BEFORE food
may be combined with metformin, sulfonylurea or thiazolidinedione
typically results in weight loss
major SE - n/v

NICE 2009 guidelines GLP-1analogue
use exenatide when need insulin (no need to have already tried) but BMI >35 (so would need high dose insulin)
continue if responds and is maintained - >1% HbA1C loss and >3% wt loss over 6/12

BEWARE - inc risk of severe pancreatitis and renal impairment

''DPP-4 inhibitors'' - Vildagliptin, sitagliptin
oral
well tolerated  - no inc hypoglyc
do not cause weight gain

NICE 2009 guidelines DPP-4 inhibitors
continue only if > 0.5% dec HBA1c in 6/12
?preferable to thiazolidinedione if wt gain problem, is CI, os has had poor response