[en] Type 2 diabetes is characterized by an insulin secretory defect that cannot compensate for insulin resistance. Such relative defect is present in the fasting state (insufficient basal insulin levels) and contributes to overnight hyperglycaemia; it is even more pronounced in the postprandial state when it is then the main responsible factor for hyperglycaemia following meals. An original approach to correct these two disturbances is to propose a therapy combining the injection of a basal insulin (most commonly at bedtime to better control fasting glycaemia) and the administration of an incretin-based medication to potentiate insulin response to the three main meals, without inducing hypoglycaemia. This latter effect can be obtained either by blocking the degradation of incretin hormones with an oral inhibitor of dipeptidyl peptidase-4 (gliptin), or by injecting an agonist of glucagon-like peptide-1 (GLP-1) receptors. These basal insulin-incretin combined therapies are well validated in various controlled trials and observational studies. Lixisenatide is the first GLP-1 receptor agonist being reimbursed in this specific indication of combination with basal insulin in Belgium. [fr] Résumé : Le diabète de type 2 est caractérisé par un déficit
insulinosécrétoire qui ne peut compenser l’insulinorésistance
généralement présente. Ce déficit relatif existe à jeun (insulinémie
basale insuffisante) et contribue à l’hyperglycémie de
fin de nuit; il est encore exacerbé en période post-prandiale
où il est alors le principal responsable de l’hyperglycémie suivant
les repas. Une approche originale pour corriger ces deux
anomalies est de proposer un traitement combinant l’injection
d’une insuline basale (généralement au coucher pour contrôler
la glycémie à jeun) et l’administration d’un médicament
à effet incrétine pour amplifier la réponse insulinosécrétoire
en réponse aux trois repas principaux, sans induire d’hypoglycémie.
Ce dernier effet peut être obtenu soit en bloquant
la dégradation des hormones incrétines par l’administration
orale d’un inhibiteur de la dipeptidyl peptidase-4 (gliptine),
soit en injectant un agoniste des récepteurs du glucagon-like
peptide-1 (GLP-1). Ces combinaisons thérapeutiques «insuline
basale + incrétine» ont été validées dans divers essais
cliniques contrôlés et dans des études observationnelles. Le
lixisénatide est le premier agoniste des récepteurs du GLP-1 à
être remboursé dans cette indication spécifique en combinaison
avec une insuline basale en Belgique.
Mots-clés : Diabète de type 2 - Gliptine - Glucagon-like
peptide-1 - Incrétine - Inhibiteur de la dipeptidyl peptidase-4
- Insuline
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