Diabetes

Almustansiriya medical college , medical college ... Al Mustansiriya. Al Mustansiriya Medical College , ...... San Diego, CA: Amylin Pharmaceuticals, Inc. 2009. 2.
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Incretin--Based Therapies for the Incretin Treatment of Type 2 Diabetes: Update on the Benefits and Risks Dr. Abdulameer Abdullah AlAl-Ashbal Ass.Prof. ; Consultant Diabetologist Almustansiriya medical college , Department of Medicine ; Alyermouk Teaching Hospital

Dr. Abdulameer Al Al--Ashbal Consultant Diabetologist; Ass. Professor of Medicine Al Mustansiriya Medical College , Department of Medicine ; Alyermouk Teaching Hospital

My disclosure : No financial relationships with any commercial interests

Very important note  Almost all the references mentioned by this lecture which deal with incretin hormones and benefits of subsequent incretin-based drugs are sponsored or supported by drugs manufactures  While almost all the references which deal with adverse effects and particularly serious ones are not sponsored or supported by drugs manufactures

The gastrointestinal tract has a crucial role in the control of

energy homeostasis through its role in

the digestion, absorption, and assimilation of ingested nutrients. Dr. Abdulameer Abdullah Al- Ashbal ; Ass.Prof. , Consultant Diabetologist

The role of

Insulin in

glucose homeostasis is a firmly established concept and forms the cornerstone of discussions of the pathophysiolgy of diabetes.

Dr. Abdulameer Abdullah Al- Ashbal ; Ass.Prof. , Consultant Diabetologist

However, how glucose enters the blood stream has profound effects on magnitude of stimulatory effect of

glucose on insulin secretion Dr. Abdulameer Abdullah Al- Ashbal ; Ass.Prof. , Consultant Diabetologist

The observation that in response to hyperglycemic stimuli, oral glucose elicits a greater insulin response than

intravenous glucose, is termed , which accounts for up to 60% of postprandial insulin release in healthy people

The observation that in response to hyperglycemic stimuli, oral glucose elicits a greater insulin response than

intravenous glucose, is termed

“The Incretin Effect “ , which accounts for up to 60% of postprandial insulin release in healthy people

The observation that in response to hyperglycemic stimuli, oral glucose elicits a greater insulin response than

intravenous glucose, is termed

“The Incretin Effect “ , which accounts for up to 60 60% % of postprandial insulin release in healthy people

The incretin effect Energy administration via The gut The parenteral route

Glucose (Insulin secretagogue)

Insulin release

Glucose (Insulin secretagogue)

Insulin release

The incretin effect Energy administration via The gut The parenteral route

Glucose



(Insulin secretagogue)

Glucose (Insulin secretagogue)

Gut--derived signals Gut (Potent insulin secretagogues)

Insulin release

Insulin release

Plasma Insulin (µU/mL)

The incretin effect**

Time (min) * Perley MI,et al. J Clin Invest. 1967; 46:1954-1962.

Plasma Insulin (µU/mL)

The incretin effect**

Time (min) * Perley MI,et al. J Clin Invest. 1967; 46:1954-1962.

Plasma Insulin (µU/mL)

The incretin effect* *

Time (min) * Perley MI,et al. J Clin Invest.

1967; 46:1954-1962.

Plasma Insulin (µU/mL)

The incretin effect**

Time (min) * Perley MI,et al. J Clin Invest. 1967; 46:1954-1962.

Incretin effect on insulin secretion People with Type 2 diabetes (n=14 (n=14 14))

80

80

60

60 Incretin effect

40 20

Insulin (mU (mU mU/l) /l)

Insulin (mU (mU mU/l) /l)

Control subjects (n=8 (n=8)

40 20 0

0 0

60

120

Time


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