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    Diabetes Care: Moving Beyond Insulin


    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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