Diabetes Treatment and Measures of Glycemia
- Zachary T. Bloomgarden, MD, is a practicing endocrinologist in New York, New York, and is affiliated with the Division of Endocrinology, Mount Sinai School of Medicine, New York, New York.
This is the fourth of a series of six articles based on presentations at the American Diabetes Association Scientific Sessions held 6–10 June 2008 in San Francisco, California.
Incretin treatment
Visboll et al. (abstract 1465) studied 13 women with gestational diabetes mellitus during the third trimester and 2–3 months following delivery, showing almost a doubling of the insulin secretory effect of oral glucose over that of intravenous glucose, evidence of reversibility of the reduced incretin effect of type 2 diabetes with improvement in glycemia. Yokoo et al. (abstract 1597) identified a protein, CF266, expressed in the intestine, which increased glucose-stimulated islet insulin secretion and appeared to have β-cell trophic effects—perhaps a novel incretin. (Abstract numbers refer to the ADA Scientific Sessions, Diabetes 57 [Suppl. 2], 2008).
A number of studies were presented of glucagon-like peptide-1 (GLP-1) receptor activators. Novel formulations are being explored. Asakura et al. (abstract 12) synthesized glycosylated GLP-1 by chemical and enzymatic modifications, showing resistance to degradation by dipeptidyl peptidase-4 with preservation of GLP-1 receptor binding and functional activity and with a 10- to 100-fold increase in duration of activity and glucose-lowering potency in db/db mice. Blase et al. (abstract 195) administered 60–1,800 μg intranasal exenatide in a formulation containing an absorption enhancer to 17 type 2 diabetic patients, finding therapeutic plasma levels and reduction in glycemia after a standardized meal. Although nausea, vomiting, and sneezing occurred in 6, 5, and 2 patients, respectively, this might be an effective therapeutic approach. Costello et al. (abstract 198) administered GLP-1 adsorbed to Technosphere microparticles by inhalation in 26 healthy individuals, with a rapid increase in plasma GLP-1 to levels >100 pmol/l at 1 and 1.5 mg doses, respectively, increasing insulin and reducing glucose levels. Nausea and vomiting were not reported, although cough and headache occurred. Drucker et al. (abstact …
