Incretin Hormones: The %u201CNew Wave%u201D of Diabetes Research

Incretin Hormones: The “New Wave” of Diabetes Research

By John Schieszer

WASHINGTON, DC—A better understanding of specialized incretin, or socalled

gut hormones, may lead to significant advances in the treatment and management

of type 2 diabetes, experts noted at the American Association of Clinical

Endocrinologists annual meeting. Incretin hormones are produced in the

gastrointestinal tract and serve to maintain glucose control. These findings are creating

a unique platform for new therapeutic options that improve islet function, both in the short- and long-term. It is also hoped that new information about the role of

incretin hormones will lead to improved insulin secretion by the beta-cells and

glucagon secretion by the alpha-cells. “We’re beginning to reshape our understanding

of diabetes by moving beyond a solitary focus on insulin resistance,” said

James Gavin, MD, PhD, of Emory University School of Medicine, Atlanta.

“Today we have a new appreciation for the importance of pancreatic islet health and its

essential role in achieving successful glucose control.” Two novel incretin-based classes of

investigational therapies—incretin mimetics and incretin enhancers—may provide

benefits in the battle to achieve glucose control, according to data presented at the

meeting. Incretin mimetics are injectable products that mimic the effects of

glucagonlike peptide 1, an incretin hormone. In April 2005, exendin-4 (Byetta)

became the first incretin mimetic to receive FDA approval. Incretin enhancers are oral therapies that increase the amount of incretin hormones naturally produced by the body. Several

incretin enhancers are in various phases of clinical trials, including vildagliptin

(Novartis) and MK 431 (Merck). “With the first incretin-based therapy, Byetta, the era of advances that leverage the way incretins work has arrived,” said David D’Alessio, MD, of the University

of Cincinnati, Ohio. “Incretins are of great interest since we now know they play a central role in maintaining healthy blood sugars.”This new pharmacologic approach may

lead to improved blood glucose control in many patients who are unable to reach

their target Hb A1C levels. “We now have a spectrum of drugs that affect different

aspects of blood sugar control. The era of combinations and complementary combinations

is upon us…. More drugs with different complementary actions will improve our ability to take care of patients…but we are still early in the game,” Dr D’Alessio told IMWR. Diabetes rates are skyrocketing among adults and children in both the United States and much of the industrialized

world. Despite a proliferation of many novel treatment options, the disease remains poorly controlled, and the majority of Americans with type 2 diabetes do not meet their blood glucose goals. “Although many agents are available to

treat type 2 diabetes, there remains a sea of unmet need for new and different therapies

that will help us address the growing epidemic. We’re excited about the unique

mechanisms represented by the whole new area of incretin research,” said Alan

Garber, MD, PhD, of Baylor College of Medicine, Houston, Tex.