Author: Laura Gater
Insulin treatment for patients with diabetes was a landmark of the 20th century. In the second century of caring for diabetes, new drugs and entirely new classes of drugs will be available.
The Pathogenesis of Type 2 Diabetes
Understanding the potential relationships between obesity and its metabolic consequences has helped direct pharmacologic research, according to Harold Bays, MD, FACP, medical director and president, Louisville Metabolic and Atherosclerosis Research Center, Louisville, KY. Some evidence suggests that adiposopathy (dysfunctional fat) might be more important than adiposity (increased fat). Pharmacologic research is intensely focused on correcting fat function and in decreasing fat mass, through current and investigational anti-obesity drugs.
Dr. Bays has served as a principal investigator for over 200 clinical trials, including studies of all currently marketed lipid-altering drug treatments, as well as studies of investigational drugs for obesity, diabetes mellitus, hypertension, osteoporosis, osteoarthritis, and other metabolic disorders.
Rethinking the Diagnosis and Treatment of Diabetic Microvascular Complications
Diabetic macular edema (DME) and diabetic retinopathy (DR) are leading causes of blindness in the working-age population of most developed countries. DME and DR will most likely continue to be major contributors to vision loss in the coming years, due to the increasing numbers of people with diabetes worldwide. Early detection of retinopathy in diabetics is critical in preventing visual loss, but current methods of screening fail to identify a sizable number of high-risk patients. Laser photocoagulation and vitrectomy are the two currently available interventions for DME and DR, but they only target advanced stages of the disease.
In order to implement new therapies effectively, more individuals will have to be screened for DME and DMR at earlier stages, says Dr. Ciulla.
Fluorescein angiography (FA), the method in which sodium fluorescein is intravenously administered, followed by rapid sequence photography of the retina to evaluate its circulation, is generally used for treatment planning. Its drawbacks as a screening procedure for DME and DR are its time constraints, invasiveness, expensive equipment, and adverse reactions.
Ultrasonography is another process utilized to assess the extent of DME and DR. The probe containing both the transmitter and the receiver is placed against the patient’s eye. The echoes reflect from the ocular structures, and the echoes are analyzed and displayed.
Treatment options for DR today are limited. Vitrectomy can prevent severe vision loss, and laser photocoagulation therapy can reduce DR progression, and has been proven to do so, but both treatments carry the risk of additional vision loss. Neither treatment is effective at reversing vision acuity, but both have been shown to improve patients’ quality of life and are cost-effective.
“Diabetic microvascular complications can result in severe tissue damages that may be irreversible,” explains Dr. Ciulla. “Patients that have diabetic microvascular complications must receive screening and diagnostic procedures in order to identify and monitor the progression of the tissue damages.”
The Role of Incretin Hormones in Metabolic Control
Incretins are responsible for 50 to 70 percent of the insulin response to oral glucose. Incretin hormones may be the “missing piece to the puzzle” of diabetes treatment, according to Kim Coy DeCoste, MSN, RN, CDE, Richmond, KY.
The incretin hormones that are currently under investigation are Gastric Inhibitory Polypeptide (GIP), Glucagon-like Peptide-1 (GLP-1), and Dipeptidyl Peptidase IV (DPP-IV).
GLP-1 is a product of the proglucagon gene from intestinal L-cells. Release is rapid in response to meals. It is a potent insulinotropic hormone. Impaired glucose tolerance (IGT) and type 2 diabetes manifest with lower plasma GL-1 compared to healthy controls. Most of the current research is focused on GLP-1, according to DeCoste.
“Upon ingestion of food, GLP-1 is secreted from the L-cells in the intestine,” explains DeCoste, “This, in turn, stimulates glucose-dependent insulin secretion; suppresses glucagon’s secretion; slows gastric emptying; reduces food intake; and improves insulin sensitivity. It can stimulate insulin production without causing hypoglycemia. Long-term effects demonstrated in animals show that GLP-1 increases beta-cell mass and maintains beta-cell efficiency.”
“Diabetes is a disorder bigger than just problems with insulin. Our traditional view of glucose regulation hasn’t been inaccurate, just incomplete. With the new body of knowledge that’s coming out, we’re filling in pieces of the puzzle,” concludes DeCoste.
© Copyright, peoplemenders.com Inc., 2009. All Rights Reserved.
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About the Author
Laura's writing specialties are medical, health and business topics.
Just a few of her published writings: Medical Imaging, 24x7, Podiatry Management, Strategic Healthcare Marketing, Advance for Imaging & Radiation Therapy Professionals, Podiatry Management, RT (Respiratory Therapy),Corrections Forum, Radiologic Technology, For the Record, Plastic Surgery Products, Orthodontic Products, Chiropractic Products, Podiatric Products, and The American Journal of Managed Care (supplement on NSAIDs).
Laura is also the temporary medical producer for several websites, writing news briefs. She has also done healthcare research and reports, provided public relations for several non-profit organizations and taught freelance writing classes.
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