【medical-news】肠胰岛素为基础的2型糖尿病治疗：现状和未来前景
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Incretin-Based Therapies for Type 2 Diabetes Mellitus: Current Status and Future Prospects
肠胰岛素为基础的2型糖尿病治疗：现状和未来前景
Abstract
Incretin-based therapies encompass two new classes of antidiabetic drugs: glucagon-like peptide-1 (GLP-1) receptor agonists (e.g., liraglutide, exenatide, and exenatide long-acting release), which are structurally related to GLP-1, and the dipeptidyl peptidase-4 (DPP-4) inhibitors (e.g., sitagliptin and saxagliptin), which limit the breakdown of endogenous GLP-1. To evaluate the safety and effectiveness of incretin-based therapies for the treatment of type 2 diabetes mellitus and the role of these therapies in clinical practice, a MEDLINE search (January 1985–November 2009) was conducted. Relevant references from the publications identified were also reviewed. Of 28 studies identified, 22 were randomized controlled trials. Data show that these therapies affect insulin secretion in a glucose-dependent manner, achieving clinically meaningful reductions in hemoglobin A1c levels, with very low rates of hypoglycemia. In addition, reductions in body weight have been observed with GLP-1 receptor agonists, which also exert a pronounced effect on systolic blood pressure. Various human and animal studies show that GLP-1 improves β-cell function and increases β-cell proliferation in vitro, which may slow disease progression. Thus, incretin-based therapies represent a promising addition to the available treatments for type 2 diabetes.
Introduction
The increasing prevalence of diabetes mellitus is an acknowledged world health crisis that is both a major contributor to patient morbidity and mortality and a huge economic burden.[1] The complex pathophysiology of type 2 diabetes makes effective treatment problematic. Hyperglycemia is associated with an increased risk of microvascular complications, sensory neuropathy, myocardial infarction, stroke, macrovascular mortality, and all-cause mortality.[2] Type 2 diabetes is also linked causally with obesity—in itself a global health crisis—which independently increases the risk of serious cardiovascular comorbidities.[1] Hypertension, also often associated with type 2 diabetes, can further increase cardiovascular risk.
The global economic impact of diabetes, due to premature death and complications from the disease, is considerable. At least $232 billion were spent on treatment and prevention of diabetes worldwide in 2007, with three quarters of that amount spent in industrialized countries on the treatment of long-term complications and on general care, such as efforts to prevent micro- and macrovascular complications.[3] The indirect costs of the disease must also be included in any discussion of its burden. In 2007, it was estimated that disability, lost productivity, and premature death due to diabetes cost the United States economy alone $58 billion.[1]
http://www.medscape.com/viewarticle/724847?src=rss
肠胰岛素为基础的2型糖尿病治疗：现状和未来前景
Abstract
Incretin-based therapies encompass two new classes of antidiabetic drugs: glucagon-like peptide-1 (GLP-1) receptor agonists (e.g., liraglutide, exenatide, and exenatide long-acting release), which are structurally related to GLP-1, and the dipeptidyl peptidase-4 (DPP-4) inhibitors (e.g., sitagliptin and saxagliptin), which limit the breakdown of endogenous GLP-1. To evaluate the safety and effectiveness of incretin-based therapies for the treatment of type 2 diabetes mellitus and the role of these therapies in clinical practice, a MEDLINE search (January 1985–November 2009) was conducted. Relevant references from the publications identified were also reviewed. Of 28 studies identified, 22 were randomized controlled trials. Data show that these therapies affect insulin secretion in a glucose-dependent manner, achieving clinically meaningful reductions in hemoglobin A1c levels, with very low rates of hypoglycemia. In addition, reductions in body weight have been observed with GLP-1 receptor agonists, which also exert a pronounced effect on systolic blood pressure. Various human and animal studies show that GLP-1 improves β-cell function and increases β-cell proliferation in vitro, which may slow disease progression. Thus, incretin-based therapies represent a promising addition to the available treatments for type 2 diabetes.
Introduction
The increasing prevalence of diabetes mellitus is an acknowledged world health crisis that is both a major contributor to patient morbidity and mortality and a huge economic burden.[1] The complex pathophysiology of type 2 diabetes makes effective treatment problematic. Hyperglycemia is associated with an increased risk of microvascular complications, sensory neuropathy, myocardial infarction, stroke, macrovascular mortality, and all-cause mortality.[2] Type 2 diabetes is also linked causally with obesity—in itself a global health crisis—which independently increases the risk of serious cardiovascular comorbidities.[1] Hypertension, also often associated with type 2 diabetes, can further increase cardiovascular risk.
The global economic impact of diabetes, due to premature death and complications from the disease, is considerable. At least $232 billion were spent on treatment and prevention of diabetes worldwide in 2007, with three quarters of that amount spent in industrialized countries on the treatment of long-term complications and on general care, such as efforts to prevent micro- and macrovascular complications.[3] The indirect costs of the disease must also be included in any discussion of its burden. In 2007, it was estimated that disability, lost productivity, and premature death due to diabetes cost the United States economy alone $58 billion.[1]
http://www.medscape.com/viewarticle/724847?src=rss
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