Diabetes Update

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Diabetes Update
Part 2 of 3

• Division of Endocrinology
• Department of Medicine
• Wayne State University Medical School
• Detroit, Michigan

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Why the Interest in Incretins ?
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The Incretin Defect in Type 2 Diabetes
IncretinDefect
Insulin Resistance
Relative Insulin Deficiency
HyperglycemiaType 2 Diabetes
1. Holst JJ, Gromada J. Role of incretin hormones
in the regulation of insulin secretion in
diabetic and nondiabetic humans. Am J Physiol
Endocrinol Metab. 2004287(2)E199-E206.
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GLP-1 Effects in HumansUnderstanding the Natural
Role of Incretins
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Leveraging the Therapeutic Potential of GLP-1
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ADA/EASD Consensus Statement Includes a GLP-1
Receptor Agonist
STEP 1
At diagnosis Lifestyle MET
If A1C 7
OR
Tier 2 Less well-validated therapies
STEP 2
Tier 1 Well-validated core therapies
If hypoglycemia is particularly undesirable
and/or promotion of weight loss is a
consideration
Lifestyle MET GLP-1 receptor agonist
Lifestyle MET PIO
Lifestyle MET SFU
Lifestyle MET basal insulin
Lifestyle MET PIO SFU
Lifestyle MET basal insulin
MET, metformin PIO, pioglitazone SFU,
sulfonylurea
STEP 3
Validation based on clinical trials and clinical
judgment.Insufficient clinical use to be
confident regarding safety. Adapted from Nathan
DM, et al. Diabetes Care. 2009.
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Liraglutide (Victoza)and Exenatide (Byetta)

• Newer GLP 1 analogue.
• Indicated in monotherapy or in combination with
  metformin, SU, TZD, or combination therapy.
• Dosed once or twice daily
• Uses the convenient pen.
• Maintains weight loss and glycemic control.

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Why Insulin in Type 2 Diabetes?
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Mimicking Physiology Basal and Prandial Insulin
Breakfast
Lunch
Dinner
Prandial Insulin 3/day
Plasma Insulin
Plus
Basal 1/day
400 800 1200 1600 2000 2400 400 800
Time