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Clinical Approaches to Preserving β-Cell Function in Diabetes

  • Bernardo Léo Wajchenberg
  • Rodrigo Mendes de Carvalho
Reference work entry

Abstract

In type 2 diabetes (DM2) there is progressive deterioration of β-cell function and mass. It was found that islet function was about 50 % of normal at the time of diagnosis and there was a reduction of β-cell mass of about 60 % at necropsy (accelerated apoptosis). Among the interventions to preserve the β-cells, those that lead to short-term improvement of β-cell secretion are weight loss, metformin, sulfonylureas, and insulin. Long-term improvement was demonstrated with short-term insulin therapy of newly diagnosed DM2. Besides, long-term intensive insulin therapy plus metformin or triple oral therapy (metformin + glyburide + pioglitazone) for 3.5 years enabled β-cell function to be preserved for at least that period of time. Furthermore, long-term improvement was also shown with the isolated use of anti-apoptotic drugs such as glitazones, and the use of glucagon-like peptide-1 receptor agonists (GLP-1 mimetics), not inactivated by the enzyme dipeptidyl peptidase-4, and/or to inhibit that enzyme (GLP-1 enhancers). The incretin hormones are released from the gastrointestinal tract in response to nutrient ingestion to enhance glucose-dependent insulin secretion from the pancreas and overall maintenance of glucose homeostasis. Of the incretins, only GLP-1 mimetics or enhancers can be used for the treatment of DM2. Although incretin-based medications maintain β-cell function, there is no evidence that they increase β-cell mass.

Keywords

Insulin Secretion Insulin Glargine Intensive Insulin Therapy Continuous Subcutaneous Insulin Infusion Incretin Effect 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

Abbreviations

A1c = HbA1c

Glycated hemoglobin

aGLP-1

Active glucagon-like peptide-1

ALT

Alanine aminotransferase

AST

Aspartate aminotransferase

BID

Twice a day

BMI

Body mass index

CV

Cardiovascular

CVD

Cardiovascular disease

DBP

Diastolic blood pressure

DM2

Type 2 diabetes mellitus

DPP-4

Dipeptidyl peptidase-4

ER

Endoplasmic reticulum

FA

Fatty acid

FFA

Free fatty acid

FPG

Fasting plasma glucose

GFR

Glomerular filtration rate

GIP

Glucose-dependent insulinotropic polypeptide

GLP-1

Glucagon-like peptide-1

GLP-1R

Glucagon-like peptide-1 receptor

GLP-2

Glucagon-like peptide-2

HOMA

homeostasis model assessment

HOMA-β or B

HOMA of β-cell function

IFG

Impaired fasting glucose

IGT

Impaired glucose tolerance

OW

Once a week

PI/IRI ratio

Proinsulin to total immunoreactive insulin ratio

PPARγ

Peroxisome proliferator-activated receptor γ

PPG

Postprandial plasma glucose

ROS

Reactive oxygen species

SBP

Systolic blood pressure

tGLP-1

Total GLP-1

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Copyright information

© Springer Science+Business Media Dordrecht 2015

Authors and Affiliations

  • Bernardo Léo Wajchenberg
    • 1
  • Rodrigo Mendes de Carvalho
    • 2
  1. 1.Endocrine Service and Diabetes and Heart Center of the Heart Institute, Hospital, Clinicas of The University of São Paulo Medical SchoolSão PauloBrazil
  2. 2.Clinical Endocrinologist and DiabetologistRio de JaneiroBrazil

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