Clinical Approaches to Preserving β-Cell Function in Diabetes

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


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.


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.


A1c = HbA1c

Glycated hemoglobin


Active glucagon-like peptide-1


Alanine aminotransferase


Aspartate aminotransferase


Twice a day


Body mass index




Cardiovascular disease


Diastolic blood pressure


Type 2 diabetes mellitus


Dipeptidyl peptidase-4


Endoplasmic reticulum


Fatty acid


Free fatty acid


Fasting plasma glucose


Glomerular filtration rate


Glucose-dependent insulinotropic polypeptide


Glucagon-like peptide-1


Glucagon-like peptide-1 receptor


Glucagon-like peptide-2


homeostasis model assessment

HOMA-β or B

HOMA of β-cell function


Impaired fasting glucose


Impaired glucose tolerance


Once a week

PI/IRI ratio

Proinsulin to total immunoreactive insulin ratio


Peroxisome proliferator-activated receptor γ


Postprandial plasma glucose


Reactive oxygen species


Systolic blood pressure


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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