Inhibition de la sécrétion du glucagon par les agonistes du GLP-1 et les inhibiteurs de la DPP-4

Incretin-based treatments have emerged as new modalities for the treatment of type 2 diabetes mellitus (T2DM). In contrast to current antidiabetic treatments, these agents target both insulin insufficiency and inappropriate hyperglucagonemia - two major components of type 2 diabetic pathophysiology - both known to contribute significantly to the hyperglycemic state of patients with T2DM. This article outlines the role of hyperglucagonemia in type 2 diabetic pathophysiology, summarizes the physiologic effects of glucagon-like peptide-1 (GLP-1) and gives an introduction to incretin-based treatments with emphasis on their glucagon-lowering effects. Finally, we review available glucagon data from current clinical studies (up to February 2011) on incretin-based treatment modalities (dipeptidyl peptidase-4 [DPP-4] inhibitors and GLP-1 receptor agonists). Most of these studies suggest that both DPP-4 inhibitors and GLP-1 receptor agonists lower fasting and postprandial plasma glucagon most likely contributing importantly to the glucose-lowering effect of the treatments.