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What are the newer hypoglycemic agents ?

The newer hypoglycemic agents act based on Incretin effect.Incretins are neuroendocrine substances that are released from GIT and increases the intestinal absorption of glucose and insulin release from pancreas.

They are of  two types
Glucagon like peptide 1(GLP1) that is degraded by dpp 
Glucose dependant insulinotropic peptide

GLP increases the glucose dependant insulin secretion only when the blood glucose >70  so, hypoglycemia not a problem with these agents.Following are the mechanism of actions of GLP
  • Supress glucagon secretion
  • Inhibit gastric emptying
  • Decrease appetite & food intake
There are incretin mimetics and incretin enhancers

Incretin mimetics 
Incretin mimeters are degradation resistant GLP 1 R agonist
They can be given through S/C injection

Incretin enhancers
The incretin enhancers act by inhibiting DPP-4 activity
They are available as oral preparations

Advantages of these newer incretin based therapy are 
This is associated with decreased risk of hypoglycemia
They help in B cell restoration upto 30%
Cytoprotective effect is also observed 
Helps to reduce weight .
Lipid friendly action is seen with incretin based therapy
They are able to combat the post prandial hyperglycemia that is produced by glucagon

Adverse effects Exenatide are 

Role of Amyelin in treatment of diabetes
Amyelin is a β cells product to supress α cells
Hence Synthetic amylin analogues are used to decreases α action 
These agents help to lower the postprandial hyperglycemia
Amyelin exerts centrally mediated anorectic action
This can be used as an adjuvant to insulin/SU/Metformin