Innovations in Caring for Diabetes: Emerging Treatment Options

Supported by an unrestricted educational grant from Eli Lilly & Co.

Wed August 11, 2004
4:30-6 PM

Program Faculty:
Harold Bays, MD, FACP
Thomas Ciulla, MD
Kim Coy DeCoste, MSN, RN, CDE

Reviewed by Aric Fader, PhD

Adiposity, which is an increase in fat content, plays a key role in the metabolic consequences that affect patients suffering from diabetes. Dr. Bays has developed the term “adiposopathy” to provide a label for the dysfunctional fat that may play a very important role in the metabolic syndrome and even the macrovascular complications that occur among patients with type 2 diabetes. Adiposopathy is involved in lipotoxicity that is the result of toxic free fatty acids (FFAs) that cause decreases in β-cell function, as well as other factors related to type 2 diabetes, including hypertension, insulin resistance, and vascular damage. A manuscript that Dr. Bays submitted to Obesity Research describes the impact of adiposopathy in depth, as well as the targets of obesity treatment and the potential benefits of PPAR α and γ agonists, and that paper is due for publication in September of 2004.

Dr. Ciulla described in depth the clinical impact of diabetic microvascular complications (DMC), which include diabetic neuropathy, diabetic retinopathy and macular edema, and diabetic nephropathy. The incidence rates of all three DMC, as well as the diagnostic procedures that can be utilized to detect them and track the progression were also discussed. In addition, the presenter made it clear to the audience that all patients afflicted with diabetes must receive screening and diagnostic procedures at least once every year in order to identify and monitor the progression of the tissue damages that result from DMC.

The role that incretin hormones play in metabolic control was presented by Kim DeCoste. It is important for health care providers to recognize that control of blood glucose helps to prevent long-term complications, although hypoglycemia may result. Oral glucose has better efficacy on plasma insulin responses than glucose delivered intravenously, and glucagon-like peptide-1 (GLP-1) has been the focus of much recently published and ongoing research. GLP-1 can stimulate insulin production in patients without causing the hypoglycemia that can result from certain methods of blood glucose control and provides protection of βcells along with an increase in their function. Several other incretin-based therapies have also been included in recent studies, such as inhibitors of dipeptidyl peptidase IV (DPP-IV), which is an enzyme that causes inactivation of incretins. DPP-IV inhibitors, such as NVP LAF237 are currently under investigation, and the GLP-1 analog NN2211 has been shown to be resistant to DPP-IV degradation.