Current strategies for the inhibition of hepatic glucose production in type 2 diabetes

被引:38
作者
Edgerton, Dale S. [1 ]
Johnson, Kathryn M. S. [1 ]
Cherrington, Alan D. [1 ]
机构
[1] Vanderbilt Univ, Med Ctr, Dept Mol Physiol & Biophys, Nashville, TN 37232 USA
来源
FRONTIERS IN BIOSCIENCE-LANDMARK | 2009年 / 14卷
关键词
Hepatic Glucose Production; Diabetes; Metformin; Thiazolidinediones; Insulin; Incretins; Dipeptidyl Peptidase-4 Inhibitors; Pramlintide; Review; ACTIVATED-RECEPTOR-GAMMA; GLUCAGON-LIKE PEPTIDE-1; SPLANCHNIC CORTISOL PRODUCTION; ABDOMINAL FAT DISTRIBUTION; INVIVO INSULIN RESISTANCE; ADIPOSE-SPECIFIC PROTEIN; HUMAN AMYLIN ANALOG; PPAR-GAMMA; SELECTIVE AMYLIN; GENE-EXPRESSION;
D O I
10.2741/3301
中图分类号
Q5 [生物化学]; Q7 [分子生物学];
学科分类号
071010 ; 081704 ;
摘要
Diabetes is a complex disease involving multiple organs with dysregulation in glucose and lipid metabolism. Hepatic insulin insensitivity can contribute to elevated fasting glucose levels and impaired glucose tolerance in individuals with diabetes. Several currently available therapeutics address defects at the liver. Metformin inhibits glucose production, potentially through effects on AMPK. Thiazolidinediones activate PPAR-gamma and improve hepatic insulin sensitivity, primarily through indirect effects on lipid metabolism. Insulin analogs and secretagogues suppress glucose production and increase liver glucose utilization by both direct and indirect hepatic actions. Incretins, incretin mimetics, and dipeptidyl peptidase-4 inhibitors reduce postprandial hepatic glucose production by increasing insulin secretion and limiting glucagon release, as well as through possible direct effects on the liver. Pramlintide reduces the increase in plasma glucagon that occurs following a meal in individuals with diabetes, and may thereby suppress inappropriate stimulation of liver glucose production. Many other hepatic targets are being considered which may lead to alternative strategies for the treatment of diabetes. This review focuses on currently available therapeutics which target insulin resistance in the liver.
引用
收藏
页码:1169 / 1181
页数:13
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