New Treatments for Type 2 Diabetes: Roles of Incretin Therapy

SD-2-1

Journey to Individualized Insulin Therapy: From Clinical Trial to Real World Experience

sTePHen L. aTKIn

Medical Department, Weill Cornell Medical College in Qatar (WCMC-Q)

Diabetes is a chronic disease requiring ongoing medical care and well patient self-management. In addition to lifestyle modification, oral hypoglycemic agents, and glucagon-like peptide-1 receptor agonist -based therapy, exogenous insulin injection is essential in type 1 diabetes and becomes vital in patients with long-term type 2 diabetes who could not achieve optimal glycemic control. One of the risks that concerns insulin treatment most is hypoglycemia. Therefore, optimal insulin regimen should reduce the risk of hypoglycemia while improving glycemic control. As the disease progress, basal insulin initiation provides a remarkable benchmark, and rapid-acting prandial insulin doses can easily be added when optimization is needed. From certain perspectives of simplicity and convenience, premix insulin regimens could be another effective option for insulin intensification therapy. In addition to achieve glycemic control as one of the diabetes management goal, weight management and hypoglycemia risk should also be considered. Personalized diabetes treatment goal is recommended to both physicians and patients.

SD-2-2 21st Century Breakthrough of Diabetology ~Beyond Glycemic Control~

TaKasHI noMIYaMa

Department of Endocrinology and Diabetes Mellitus, School of Medicine, Fukuoka University, Japan

Because the aim of glycemic control is not only lowering blood glucose level and HbA1c but also to improve quality of life and life span of patients through preventing complications, we need to choose anti-diabetic agents which could provide tissue-protective effect beyond glycemic control. To improve glycemic control including HbA1c and glucose level is minimal requirement for us in the present era. We should treat patients with diabetes for their future. Accordingly, glycemic control is a kind of life planning of patients.

Incretin therapy has emerged as one of the most popular treatments for patients with type 2 diabetes, because of not only its’ efficacy and safety in glycemic control but also tissue-protective effect independent on glucose lowering effect. We have previously reported that Exendin-4, a GLP-1 receptor agonist, could improve atheroma formation (Diabetes 2010) and neointima formation (BBRC 2011). Further, we have recently reported anti-cancer effect of Exendin-4 (Diabetes 2014). In addition, DPP4 inhibitor linagliptin acts as vascular-protective agent through inhibition of DPP-4, anti-oxidative stress effect and direct effect on vascular smooth muscle cells (Cardiovasc Diabetol 2014). These data suggest that incretin therapy might be able to improve future of patients with type 2 diabetes beyond glycemic control.

On the other hand, SGLT2 inhibitor is also new anti-diabetic agents. A lot of benefits are estimated, such as body eight reduction. However, we need to be careful to use this, especially in Asian patients with type 2 diabetes whose main phenotype is insulin deficiency.

Almost 100 years have passed after the discovery of insulin. Anti-diabetic agents should evolve from just a glucose lowering agent into the partner of patients with diabetes to improve their future.