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Treatment of type 2 diabetes with incretin-based therapies

Department of Endocrinology, Hvidovre Hospital and University of Copenhagen, 2650 Hvidovre, Denmark.
The Lancet (Impact Factor: 45.22). 10/2008; 373(9662):438-9. DOI: 10.1016/S0140-6736(08)61247-7
Source: PubMed
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    • "Recently developed pharmacological therapies show improved control of blood glucose levels in the treatment of Type II diabetics (e.g. Liraglutide (NN2211) [48] [49]) but Type I diabetics are dependent on insulin injection which results in fluctuations in their physiological blood glucose levels. Elevated blood glucose levels triggers the onset of secondary microvascular and neurologic complications such as cardiovascular disease, glomerularnephritis and proliferative diabetic retinopathy (PDR) [50]. "
    Biomaterials Developments and Applications : Advances in Biology and Medicine Series, Edited by Bourg H and Lisle A, 01/2010: chapter Biomaterials in Dentistry and Medicine: pages 231-289; Nova Publishers NY., ISBN: ISBN: 978-1-60876-476-1
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    ABSTRACT: Incretins are gut hormones that are secreted from enteroendocrine cells into the blood within minutes after eating. One of their many physiological roles is to regulate the amount of insulin that is secreted after eating. In this manner, as well as others to be described in this review, their final common raison d'être is to aid in disposal of the products of digestion. There are two incretins, known as glucose-dependent insulinotropic peptide (GIP) and glucagon-like peptide-1 (GLP-1), that share many common actions in the pancreas but have distinct actions outside of the pancreas. Both incretins are rapidly deactivated by an enzyme called dipeptidyl peptidase 4 (DPP4). A lack of secretion of incretins or an increase in their clearance are not pathogenic factors in diabetes. However, in type 2 diabetes (T2DM), GIP no longer modulates glucose-dependent insulin secretion, even at supraphysiological (pharmacological) plasma levels, and therefore GIP incompetence is detrimental to beta-cell function, especially after eating. GLP-1, on the other hand, is still insulinotropic in T2DM, and this has led to the development of compounds that activate the GLP-1 receptor with a view to improving insulin secretion. Since 2005, two new classes of drugs based on incretin action have been approved for lowering blood glucose levels in T2DM: an incretin mimetic (exenatide, which is a potent long-acting agonist of the GLP-1 receptor) and an incretin enhancer (sitagliptin, which is a DPP4 inhibitor). Exenatide is injected subcutaneously twice daily and its use leads to lower blood glucose and higher insulin levels, especially in the fed state. There is glucose-dependency to its insulin secretory capacity, making it unlikely to cause low blood sugars (hypoglycemia). DPP4 inhibitors are orally active and they increase endogenous blood levels of active incretins, thus leading to prolonged incretin action. The elevated levels of GLP-1 are thought to be the mechanism underlying their blood glucose-lowering effects.
    Pharmacological reviews 01/2009; 60(4):470-512. DOI:10.1124/pr.108.000604 · 18.55 Impact Factor
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