Incretin mimetics, like exenatide, improve glycemic control for patients with type 2 diabetes mellitus by enhancing glucose-dependent insulin secretion by pancreatic β cells, suppressing inappropriately elevated glucagon secretion, and slowing gastric emptying.
44 Adverse effects of exenatide may include hypoglycemia; stomach pain; nausea, vomiting, and diarrhea; hives, rash, and itching; difficulty breathing or swallowing; swelling of the face, throat, tongue, lips, eyes, hands, feet, ankles, or lower legs; hoarseness; or decreased urination.
61
Dipeptidyl peptidase-4 inhibitors, like sitagliptin, lower blood glucose through different pathways by increasing insulin biosynthesis and release, inhibiting the liver's glucose production and delaying gastric emptying. The manufacturer of sitagliptin will be testing this product in children in the near future.
45 Adverse effects of sitagliptin may include stuffy or runny nose, sore throat, headache, stomach pain, and diarrhea.
62
Amylin analogs, like pramlintide, delay gastric emptying, decrease postprandial glucagon release, and regulate food intake. Amylin is a hypoglycemic hormone co-secreted with insulin by the β cells, but it is degraded too quickly to have clinical applications. Amylin analogs may be used to treat type 1 or type 2 diabetes mellitus in combination with insulin.
46 Adverse effects of pramlintide include gastrointestinal upset; excessive tiredness or dizziness; coughing or sore throat; joint pain; and redness, swelling, bruising, or itching at the injection site.
63
These agents have not been tested in large-scale studies with children.
64 Additional research is needed to determine efficacy for this patient population.