The gut expresses peptide hormones in endocrine cells and neuropeptides in autonomic nerves. Several of these peptides have
the ability to stimulate insulin secretion. Gut hormones that are released after meal ingestion and stimulate insulin secretion
postprandially are called incretins. In humans, glucose-dependent insulinotropic polypeptide (GIP) and glucagon-like peptide-1
(GLP-1) are the most important incretins. The potential use of these insulinotropic gut peptides for the treatment of diabetes
has been considered. This has been most successful for GLP-1, which exerts antidiabetogenic properties in subjects with type
2 diabetes by stimulating insulin secretion, increasing à-cell mass, inhibiting glucagon secretion, delaying gastric emptying,
and inducing satiety. However, GLP-1 is rapidly degraded by the enzyme dipeptidyl peptidase IV (DPPIV), making it unattractive
as a therapeutic agent because of a very short half-life. Successful strategies to overcome this difficulty are the use of
DPPIV-resistant GLP-1 receptor agonists, such as NN2211 or exendin-4, and the use of inhibitors of DPPIV, such as NVPDPP728
and P32/98. These two approaches are explored in clinical investigations.