Incretin hormones, a new wave of promising diabetes research

A new understanding of specialized incretin (or gut) hormones may lead to significant advances in the treatment and management of type 2 diabetes. This conclusion and other recent research were reported recently at the 14th Annual Meeting and Clinical Congress of the American Association for Clinical Endocrinologists (AACE) in Washington, DC.

Diabetes is a disease of epidemic proportions, affecting more than 20 million Americans. 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.

“While many different agents are available to treat type 2 diabetes, there remains a sea of unmet need for new and different therapies that will help us address the growing epidemic,” said Alan J. Garber, M.D., Ph.D., member of the AACE board of directors and Professor of Medicine at Baylor College of Medicine. “As endocrinologists, we’re excited about the unique mechanisms represented by the whole new area of incretin research.”

To provide information and insights to journalists, AACE hosted an expert media “teach in” today to focus attention on promising incretin-based therapies in development that could result in new and more effective approaches to type 2 diabetes treatments.

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 unique 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, M.D. Ph.D., AACE member and Clinical Professor of Medicine at Emory University School of Medicine. “Today we have a new appreciation for the importance of pancreatic islet health and its essential role in achieving successful glucose control.”

Two novel incretin-based classes of investigational therapies – incretin mimetics and incretin enhancers – may offer 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. Byetta® (exendin-4) , the first incretin mimetic, was approved by the FDA 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 Vildagliptin (Novartis) and MK 431 (Merck).

“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.”

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.

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