Current and Emerging Treatment Options in Diabetes Care

Abstract

Diabetes constitutes an increasing threat to human health, particularly in newly industrialized and densely populated countries. Type 1 and type 2 diabetes arise from different etiologies but lead to similar metabolic derangements constituted by an absolute or relative lack of insulin that results in elevated plasma glucose. In the last three decades, a set of new medicines built upon a deeper understanding of physiology and diabetic pathology have emerged to enhance the clinical management of the disease and related disorders. Recent insights into insulin-dependent and insulin-independent molecular events have accelerated the generation of a series of novel medicinal agents, which hold the promise for further advances in the management of diabetes. In this chapter, we provide a historical context for what has been accomplished to provide perspective for future research and novel emerging treatment options.

Gut-Brain Cross-Talk in Metabolic Control

“…GLP-1 targets the CNS to promote satiation and the pancreas to intensify insulin secretion, and through laborious pharmacological optimization, GLP-1-based therapies have now obtained pharmacological pole-position for the dual treatment of obesity and diabetes (Clemmensen et al, 2016). As a stand-alone therapy for type 2 diabetes, GLP-1R agonists provide relevant yet insufficient metabolic benefits that are limited by a dose-dependent increase in adverse GI events.…”

Hypothalamic AMPK and energy balance

“…Obesity and its associated metabolic complications, such as cancer, cardiovascular diseases and T2D, cause numerous deaths per year worldwide. However, obesity is also considered as the most preventable epidemic . However, despite numerous important investments in education and public engagement, government‐led strategies are relatively unsuccessful.…”

EJE PRIZE 2017: Hypothalamic AMPK: a golden target against obesity?

“…Obesity causes thousands of deaths per year worldwide, directly and indirectly due to comorbidities including cancer, cardiovascular disease and T2D, and yet, it is the most preventable epidemic (96, 119, 120, 121). However, despite significant investments in education and public engagement, government-led policies are relatively ineffective.…”

“…However, the implementation of optogenetics for hypothalamic intervention in humans also seems a distant possibility. Perhaps a more realistic strategy would be to use peptide conjugates (with other peptides or steroid hormones) (120, 121, 125, 126, 127) in a targeted approach. For example, a chimera containing GLP-1 plus an estrogen, (125) or glucagon plus T3 (127), would allow quite a precise targeting of AMPK neurons in the VMH, although the fact that other neuronal populations would be affected (128) would limit specificity.…”