open access

Vol 58, No 6 (2007)
Review article
Published online: 2007-11-21
Submitted: 2013-02-15
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Incretin hormones in the treatment of type 2 diabetes. Part I: Influence of insulinotropic gut-derived hormones (incretins) on glucose metabolism

Beata Matuszek, Monika Lenart-Lipińska, Andrzej Nowakowski
Endokrynologia Polska 2007;58(6):522-528.

open access

Vol 58, No 6 (2007)
Review article
Published online: 2007-11-21
Submitted: 2013-02-15

Abstract

Insulinotropic gut-derived hormones (incretins) play a significant role in the regulation of glucose homeostasis in healthy subjects and are responsible for 50-70% of insulin response to a meal. The main mediators of the incretin effect are glucose-dependent insulinotropic polypeptide (GIP) and glucagon-like peptide 1 (GLP-1). However, in patients with type 2 diabetes the effect of incretins action is to a large extent impaired, which seems to explain disturbed secretional activity of β cells in pancreatic islets. Detailed analysis of incretin defect proved that GIP secretion remains within physiological limits, whereas GLP-1 secretion is significantly decreased. Nevertheless, GLP-1 insulinotropic effect is preserved and GIP effect is significantly impaired. In consequence, substitutional GLP-1 administration aiming at the reduction of its deficiency, seems to be logical therapeutic management, because despite a physiologically retained quantity response from GIP, resistance to this peptide is frequently found. Therefore, particularly promising are the results of clinical studies with the use of GLP-1 analogues , GLP-1 receptors activation, as well as the inhibitors of dipeptidyl peptidase-IV (DPP IV), the enzyme responsible for incretin proteolysis, which restores the proper function of the intestinal-pancreatic axis in subjects with type 2 diabetes and creates new possibilities of a glycaemia reducing therapy and improvement in quality of life in this group of patients.

Abstract

Insulinotropic gut-derived hormones (incretins) play a significant role in the regulation of glucose homeostasis in healthy subjects and are responsible for 50-70% of insulin response to a meal. The main mediators of the incretin effect are glucose-dependent insulinotropic polypeptide (GIP) and glucagon-like peptide 1 (GLP-1). However, in patients with type 2 diabetes the effect of incretins action is to a large extent impaired, which seems to explain disturbed secretional activity of β cells in pancreatic islets. Detailed analysis of incretin defect proved that GIP secretion remains within physiological limits, whereas GLP-1 secretion is significantly decreased. Nevertheless, GLP-1 insulinotropic effect is preserved and GIP effect is significantly impaired. In consequence, substitutional GLP-1 administration aiming at the reduction of its deficiency, seems to be logical therapeutic management, because despite a physiologically retained quantity response from GIP, resistance to this peptide is frequently found. Therefore, particularly promising are the results of clinical studies with the use of GLP-1 analogues , GLP-1 receptors activation, as well as the inhibitors of dipeptidyl peptidase-IV (DPP IV), the enzyme responsible for incretin proteolysis, which restores the proper function of the intestinal-pancreatic axis in subjects with type 2 diabetes and creates new possibilities of a glycaemia reducing therapy and improvement in quality of life in this group of patients.
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Keywords

type 2 diabetes; incretin effect; GLP-1; GIP

About this article
Title

Incretin hormones in the treatment of type 2 diabetes. Part I: Influence of insulinotropic gut-derived hormones (incretins) on glucose metabolism

Journal

Endokrynologia Polska

Issue

Vol 58, No 6 (2007)

Pages

522-528

Published online

2007-11-21

Bibliographic record

Endokrynologia Polska 2007;58(6):522-528.

Keywords

type 2 diabetes
incretin effect
GLP-1
GIP

Authors

Beata Matuszek
Monika Lenart-Lipińska
Andrzej Nowakowski

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