Diabetes Care: Moving Beyond Insulin

From the WebMD Archives

May 24, 2001 -- A new frontier in diabetes care may be on its way. Most people link the treatment of diabetes with the hormone insulin -- which makes sense since insulin is currently the mainstay of therapy for this disease. New studies, however, demonstrate that other hormones may also have important therapeutic effects.

Diabetes is a condition in which the body does not use sugar properly. Type 1 diabetes usually occurs in children and young adults and is caused by an error in the immune system, making it attack the cells in the pancreas that produce insulin. The more common form of diabetes is type 2, however. This usually starts in middle or older age and is caused by a combination of the pancreas cells being unable to produce enough insulin and the body developing a resistance to the effects of insulin.

According to the American Diabetes Association, about 15.7 million Americans have diabetes, and over 90% of these people have type 2 diabetes. While not immediately life-threatening without insulin treatment, like type 1 diabetes, untreated type 2 diabetes can eventually lead to serious complications in almost every organ of the body, including the eyes, heart, and kidneys.

Two new studies have demonstrated that a hormone called glucagon-like peptide (GLP)-1 might be an important new therapy for type 2 diabetes, possibly even offering a cure, by not only stimulating the body to produce insulin in a normal fashion but also causing it to produce new pancreas cells (called beta cells) that produce insulin.

"This is perhaps only the tip of the iceberg in terms of the newer compounds and hormones that we may be able to look into to help with diabetes control," says Claresa Levetan, MD, who reviewed the studies for WebMD. "It is my personal opinion as an endocrinologist who takes care of large numbers of patients with both type 1 and 2 diabetes that even patients who are on tight control, even patients who are on insulin pump therapy where we're trying to mimic the pancreas as much as possible, there still is room for improvement. This [research] demonstrates that there are other possible ways that we can improve diabetes control by having greater regulation on [the pattern of natural insulin production in the body]."

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Levetan is an assistant clinical professor of medicine at George Washington University School of Medicine in Washington, and director of diabetes education at MedStar Health, a seven-hospital system. She is also associate editor of the ADA's journal Clinical Diabetes and a member of the board of directors of the American Association of Clinical Endocrinologists.

In one study, senior author Michael A. Nauck, MD, and colleagues gave eight people with type 2 diabetes GLP-1 continuously overnight, by intravenous injection. The hormone made their bodies produce insulin in the natural pattern that people without diabetes produce the hormone.

Early findings from this study offer hope that GLP-1 or similar compounds that have a longer duration of action could be used to help people with type 2 diabetes produce insulin normally, says Nauck, from the department of internal medicine at Ruhr University, Diabeteszentrum, in Bad Lauterberg, Germany.

In another study, Riccardo Perfetti, MD, PhD, and colleagues from the division of endocrinology and metabolism at Cedars-Sinai Medical Center in Los Angeles demonstrated that placing immature pancreatic cells in contact with GLP-1 makes them turn into insulin-producing beta cells.

"Once [the cells] acquire the ability to make insulin," Perfetti tells WebMD, "they also learn how to respond to glucose. This is a key point because ... these cells shut off their production of insulin if there is no need for it."

Both studies are published in the April issue of the medical journal Diabetes.

Based on these early findings, says Dariush Elahi, PhD, GLP-1, "might cure diabetes if it does what everyone thinks it does. ... But there are problems. Now you have new beta cells, ... but something happened before that made them go away. Can you stop it from happening again?"

Elahi is associate professor of medicine at Harvard Medical School and director of the geriatrics research lab at Massachusetts General Hospital, in Boston.

In response to this, Perfetti says that research into transplanting insulin-producing cells into people with diabetes has addressed this problem with drugs that block the immune system so that it doesn't attack the new beta cells.

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"This [research] opens up some new possibilities for treatment that are very different from the treatments available previously [for diabetes]," says Levetan. "We're going into a new area of diabetes in terms of thinking about using naturally produced hormones in the body that we haven't used before. These studies give a lot of hope to people with diabetes that we're really looking into the underlying mechanisms of what's wrong in this disease."

WebMD Health News Reviewed by Gary D. Vogin, MD
© 2001 WebMD, Inc. All rights reserved.

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