Time for testing incretin therapies in early type 1 diabetes?
Incretin-based compounds, including glucagon-like peptide-1 receptor agonists and dipeptidyl-peptidase-4 inhibitors, have emerged as a new class of agents for the treatment of type 2 diabetes. In this article, the potential and supporting evidence for extending their use to early type 1 diabetes are reviewed. The rationale relies on the assumption that these drugs, in addition to their action on insulin secretion and glucose regulation, may be effective in preserving and even expanding the beta-cell mass. This assumption is based on data from in vitro and animal studies, with no clear demonstrations in humans. This class of drugs may represent an entirely new approach to the treatment of type 1 diabetes, focused on protection and preservation of beta-cells, an ideal complement to immune interventions inhibiting or modulating the pathogenetic autoimmune process. The ideal candidates for this treatment are patients at the time of clinical onset of type 1 diabetes or individuals with preclinical type 1 diabetes who still have a significant viable beta-cell mass.
Department of Internal Medicine, San Raffaele Scientific Institute and Vita Salute San Raffaele University, 20132 Milan, Italy. bosi.emanuele@hsr.it
Emanuele
E
Bosi
D000911:Antibodies, Monoclonal / Q000627:therapeutic use; D049109:Cell Proliferation / Q000187:drug effects; D003922:Diabetes Mellitus, Type 1 / Q000188:drug therapy*; D054873:Dipeptidyl-Peptidase IV Inhibitors / Q000627:therapeutic use; D000077270:Exenatide; D005749:Gastric Inhibitory Polypeptide / Q000627:therapeutic use; D052216:Glucagon-Like Peptide 1 / Q000627:therapeutic use; D006801:Humans; D007004:Hypoglycemic Agents / Q000009:adverse effects / Q000627:therapeutic use*; D054795:Incretins / Q000009:adverse effects / Q000627:therapeutic use*; D050417:Insulin-Secreting Cells / Q000187:drug effects; D053645:Interleukin-2 Receptor alpha Subunit / Q000276:immunology; D010455:Peptides / Q000627:therapeutic use; D014688:Venoms / Q000627:therapeutic use
D000911:Antibodies, Monoclonal; D054873:Dipeptidyl-Peptidase IV Inhibitors; D007004:Hypoglycemic Agents; D054795:Incretins; D053645:Interleukin-2 Receptor alpha Subunit; D010455:Peptides; D014688:Venoms; D005749:Gastric Inhibitory Polypeptide; D052216:Glucagon-Like Peptide 1; D000077270:Exenatide