Obesity and type 2 diabetes mellitus (T2DM) are widespread, non-communicable diseases that are responsible for considerable levels of morbidity and mortality globally, primarily in the form of cardiovascular disease (CVD). Changes to lifestyle and behaviour have insufficient long-term efficacy in most patients with these diseases; metabolic surgery, although effective, is not practically deliverable on the scale that is required. Over the past two decades, therapies based on incretin hormones, spearheaded by glucagon-like peptide 1 (GLP1) receptor agonists (GLP1RAs), have become the treatment of choice for obesity and T2DM, and clinical evidence now suggests that these agents have benefits for CVD. We review the latest advances in incretin-based pharmacotherapy. These include ‘GLP1 plus’ agents, which combine the known advantages of GLP1RAs with the activity of additional hormones, such as glucose-dependent insulinotropic peptide, glucagon and amylin, to achieve desired therapeutic goals. Second-generation non-peptidic oral GLP1RAs promise to extend the benefits of GLP1 therapy to those who do not want, or cannot have, subcutaneous injection therapy. We conclude with a discussion of the knowledge gaps that must be addressed before incretin-based therapies can be properly deployed for maximum benefit in the treatment of obesity and T2DM.

肥胖和 2 型糖尿病 (T2DM) 是广泛存在的非传染性疾病，在全球范围内造成相当高的发病率和死亡率，主要表现为心血管疾病 (CVD)。对于大多数患有这些疾病的患者来说，生活方式和行为的改变没有足够的长期疗效；代谢手术虽然有效，但实际上无法达到所需的规模。在过去的二十年中，以胰高血糖素样肽 1 (GLP1) 受体激动剂 (GLP1RA) 为首的基于肠促胰岛素激素的疗法已成为肥胖和 T2DM 的首选治疗方法，现在的临床证据表明，这些药物对化学气相沉积。我们回顾了基于肠促胰岛素的药物治疗的最新进展。其中包括“GLP1 plus”药物，它将 GLP1RA 的已知优势与其他激素（如葡萄糖依赖性促胰岛素肽、胰高血糖素和胰岛淀粉样多肽）的活性相结合，以实现所需的治疗目标。第二代非肽类口服 GLP1RA 有望将 GLP1 疗法的益处延伸至那些不想或无法接受皮下注射疗法的患者。最后，我们讨论了在正确部署基于肠促胰素的疗法以在肥胖和 T2DM 治疗中获得最大益处之前必须解决的知识差距。