[Role of insulin secretagogues in the treatment of type 2 diabetes].
Type 2 diabetes mellitus is characterised by both insulin resistance and impaired insulin secretion. It is a chronic disease, which progresses over time, essentially due to a progressive failure of B cells. Non-pharmacological approaches including diet modification, weight control and regular exercise form the cornerstone of therapy. In case of failure of life-style approaches, clinicians have to use oral antidiabetic drugs. Amongst the different glucose-lowering agents, two kinds of insulin secretagogues may be used: sulphonylureas or, more recently, glinides (meglitinide derivatives). After having analysed their mechanism of action and pharmacological characteristics, we describe their role in the management of type 2 diabetic patients. Insulin secretagogues can be used as monotherapy, in association with metformin or a glitazone, or even in combination with a basal insulin regimen. Finally, this article briefly discusses the potential of new insulin secretagogues, called incretins. The metabolic effects of glucagon-like peptide-1 (GLP-1) appear very promising, and can be either reproduced by long-acting GLP-1 analogues, or enhanced by inhibitors of dipeptidylpeptidase-IV, an enzyme that destroys GLP-1.
Radermecker
R P
RP
Service de Diabétologie, Nutrition et Maladies métaboliques, Département de Médecine, CHU Sart Tilman. Regis.Radermecker@ulg.ac.be
D000284:Administration, Oral; D001549:Benzamides / Q000494:pharmacology / Q000627:therapeutic use*; D003924:Diabetes Mellitus, Type 2 / Q000188:drug therapy* / Q000503:physiopathology; D005934:Glucagon; D052216:Glucagon-Like Peptide 1; D006801:Humans; D007004:Hypoglycemic Agents / Q000494:pharmacology / Q000627:therapeutic use*; D007328:Insulin / Q000378:metabolism*; D000078790:Insulin Secretion; D010446:Peptide Fragments; D011498:Protein Precursors
D001549:Benzamides; D007004:Hypoglycemic Agents; D007328:Insulin; D010446:Peptide Fragments; D011498:Protein Precursors; D052216:Glucagon-Like Peptide 1; C030516:meglitinide; D005934:Glucagon