A new understanding of specialised gut hormones may lead to advances in the treatment and management of type 2 diabetes, offering patients a viable option in controlling fluctuating blood glucose levels that is characteristic of the disease.
Diabetes has become a disease of epidemic proportions, affecting more than 20 million Americans and approximately 194 million worldwide. Despite the proliferation of many new, novel treatment options, the disease remains poorly controlled and the majority of people with Type 2 diabetes have not achieved the goals for blood glucose levels and are at risk for serious health complications.
Researchers identified two novel incretin-based classes of investigational therapies, incretin mimetics and incretin enhancers, as offering new and additional benefits in the battle to achieve glucose control.
Incretin mimetics are injectable products that mimic the effects of GLP-1, an incretin hormone. The Food and Drug Administration (FDA) approved Byetta (exendin-4), the first incretin mimetic, on April 29, 2005. Incretin enhancers are oral therapies that increase the level of incretin hormones naturally produced by the body.
Several incretin enhancers are in various phases of clinical trials, including Novartis' Vildagliptin (phase III) and Merck's MK 431 (phase III).
"With the first incretin-based therapy, Byetta, approved last month, the era of advances that leverage the way incretins work has arrived," said David D'Alessio, associate professor of medicine, University of Cincinnati.
"Incretins are of great interest since we now know they play a central role in maintaining healthy blood sugar levels," he added.
Recent advances in diabetes research have revealed the important role of incretin hormones, which are produced in the gastrointestinal tract, in maintaining glucose control. These findings create a platform for new therapeutic options that improve pancreatic islet function, both short and long term, including insulin secretion by the beta cells and glucagon secretion by the alpha cells.
"We're beginning to reshape our understanding of diabetes by moving beyond a solitary focus on insulin resistance," said James Gavin, AACE member and clinical professor of medicine at Emory University School of Medicine.
Type 2 diabetes, also known as adult-onset or non-insulin-dependent diabetes (NIDDM), results when cells in the body no longer respond properly to insulin (insulin resistance) and/or the beta cells in the pancreas do not produce enough insulin. As a result, blood glucose levels rise to an unhealthy level. Type 2 diabetes occurs most frequently in adults, but is seen increasingly in adolescents as well.
This research was reported at the 14th Annual Meeting and Clinical Congress of the American Association for Clinical Endocrinologists (AACE) in Washington DC.