Remodeling of the endocrine pancreas: the central role of amylin and insulin resistance.
BACKGROUND
Remodeling of the endocrine pancreas, caused by the deleterious effects of amylin as it is co-synthesized, co-packaged, and co-secreted with insulin, gives clinicians and researchers cause to ponder.


METHODS
A literature search was done, and relevant publications and texts on amylin and islet amyloid polypeptide (IAPP) were reviewed.


RESULTS
The mechanisms and clinical consequences attributed to the remodeling of the endocrine pancreas, along with proposals for reevaluating the methods of treating patients who have type 2 diabetes are illustrated and discussed.


CONCLUSIONS
In addition to controlling the devastating effects ofglucotoxicity, lipotoxicity, and hypertension, we should consider the newer hypoglycemic agents with regard to their effects on the remodeling of the endocrine pancreas. This remodeling results in structural and subsequent functional changes, causing continued elevations of hemoglobin A1C. Studies are indicated to determine whether amylin (IAPP) may be implicated in the remodeling of the arterial vessel wall, the glomerulus of the kidney, and the cardiac interstitium.
Hayden
M R
MR
Department of Cardiovascular Atherosclerosis, Metabolism and Aging, Camdenton Medical Center, MO 65020, USA.
Tyagi
S C
SC
D000284:Administration, Oral; D000682:Amyloid / Q000502:physiology*; D003924:Diabetes Mellitus, Type 2 / Q000188:drug therapy / Q000473:pathology; D006801:Humans; D007004:Hypoglycemic Agents / Q000008:administration & dosage; D007333:Insulin Resistance / Q000502:physiology*; D058228:Islet Amyloid Polypeptide; D007515:Islets of Langerhans / Q000166:cytology* / Q000502:physiology
D000682:Amyloid; D007004:Hypoglycemic Agents; D058228:Islet Amyloid Polypeptide