Gene/Protein Disease Symptom Drug Enzyme Compound
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Query: UMLS:C0011849 (diabetes)
 277,896 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Inhibition of dipeptidyl peptidase 4 (DPP-4) is a novel treatment for type-2 diabetes. DPP-4 inhibition prevents the inactivation of glucagon-like peptide 1 (GLP-1), which increases levels of active GLP-1. This increases insulin secretion and reduces glucagon secretion, thereby lowering glucose levels. Several DPP-4 inhibitors are in clinical development. Most experience so far has been with sitagliptin (Merck; approved by the FDA) and vildagliptin (Novartis; filed). These are orally active compounds with a long duration, allowing once-daily administration. Both sitagliptin and vildagliptin improve metabolic control in type-2 diabetes, both in monotherapy and in combination with metformin and thiazolidinediones. A reduction in HbA(1c) of approximately 1% is seen in studies of DPP-4 inhibition of up to 52 weeks' duration. DPP-4 inhibition is safe and well tolerated, the risk of hypoglycaemia is minimal, and DPP-4 inhibition is body-weight neutral. DPP-4 inhibition is suggested to be a first-line treatment of type-2 diabetes, particularly in its early stages in combination with metformin. However, the durability and long-term safety of DPP-4 inhibition remain to be established.
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PMID:DPP-4 inhibitors. 1805 33

The incretin system has proven to be a new source of glucose-lowering drugs. Glucon-like peptide-1 (GLP-1) and glucose-dependent insulinotropic peptide (GIP) are the incretins which are degraded by dipeptidyl peptidase-4 (DPP-4). GLP-1 is the major relevant incretin in type 2 diabetes, GIP has little stimulatory capacity. Oral inhibitors of DPP-4 increase GLP-1 levels and this leads to lower glucose levels caused by increased insulin secretion and decreased glucagon levels. There are currently two oral drugs registered with the European Medicinal Evaluation Agency: sitagliptin and vidagliptin. Both compounds have shown similar effects to date. A main issue is to establish the value of this new class of drugs in the treatment of patients with type 2 diabetes. In this article, results from randomized studies on the efficacy of the new drugs are discussed: 1. comparison with placebo to establish long-term efficacy, 2. comparison with placebo when added to the regimen in patients failing on another oral glucose-lowering drug and 3. comparison in a head-to-head trial with other conventional drugs. Also, the combination with insulin is a promising new avenue. Both efficacy and safety (regarding hypoglycemia, body weight changes and changes in lipid levels) are major components in the decision of the optimal pharmacological treatment, which is discussed in this article. Finally, the advantages, disadvantages and risks of the new anti-diabetic compounds are highlighted, which are applicable to other classes of diabetes drugs.
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PMID:DPP-4 Inhibitors and Combined Treatment in Type 2 Diabetes: Re-evaluation of Clinical Success and Safety. 1808 70

Dipeptidyl peptidase IV (DPP-IV) is a valid drug target for type-2 diabetes and DPP-IV inhibitors have been proven to efficiently improve glucose tolerance. In our study, 3D pharmacophore models were generated using a training set of 22 DPP-IV inhibitors. The best model consisted of important chemical features and mapped well into the active site of DPP-IV. The model gave high correlation coefficients of 0.97 and 0.84 for the training set and the test set, respectively, showing its good predictive ability for biological activity. Furthermore, the pharmacophore model demonstrated the capability to retrieve inhibitors from database with a high enrichment factor of 42.58. All results suggest that the model provides a useful tool for designing novel DPP-IV inhibitors.
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PMID:A three-dimensional pharmacophore model for dipeptidyl peptidase IV inhibitors. 1820 85

Type 2 diabetes is a heterogeneous, polygenic disorder in which dysfunction in a number of important metabolic pathways appears to play roles. Although it remains unclear exactly which event triggers the disorder, beta-cell dysfunction is a key element in the underlyingpathophysiology. Both impaired insulin secretion and insulin resistance contribute to the hyperglycemic state that causes the devastating cardiovascular, neurologic, and renal effects characteristic of type 2 diabetes. To prevent these complications, the American Diabetes Association recommends maintaining A1C levels below 7%. A1C has long been the target of diabetes therapy, and while this remains true in those with A1C levels above 8.4%, it is now apparent that in those with mild to moderate diabetes, postprandial glucose excursions may be of greater importance. Postprandial hyperglycemia occurs in 74% of those diagnosed with diabetes and 39% of those with optimal A1C levels. Involvement of impaired alpha-cell function has recently been recognized in the pathophysiology of type 2 diabetes. As a result of this dysfunction, glucagon and hepatic glucose levels that rise during fasting are not suppressed with a meal. Given inadequate levels of insulin and increased insulin resistance, hyperglycemia results. The incretins are important gut mediators of insulin release, and in the case of GLP-1, of glucagon suppression. Although GIP activity is impaired in those with type 2 diabetes, GLP-1 insulinotropic effects are preserved, and thus GLP-1 represents a potentially beneficial therapeutic option. However, like GIP, GLP-1 is rapidly inactivated by DPP-IV in vivo. Two therapeutic approaches to this problem have been developed: GLP-1 analogs with increased half-lives, and DPP-IV inhibitors, which prevent the breakdown of endogenous GLP-1 as well as GIP. Both classes of agent have shown promise, with potential not only to normalize fasting and postprandial glucose levels but also to improve beta-cell functioning and mass.
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PMID:Pathophysiology of type 2 diabetes and the role of incretin hormones and beta-cell dysfunction. 1821 45

Incretin therapeutics address an unmet need in diabetes by effectively treating postprandial glycemia. In addition, they present interesting possibilities for future therapy as they were suggested in preclinical studies to have effects on pancreatic beta-cell neogenesis. When used in combination with metformin, sulfonylureas, or TZDs, GLP-1 analogs such as exenatide and DPP-IV inhibitors such as sitagliptin reduce A1C, fasting glucose levels, and postprandial glucose levels with few additional adverse events. Incretin therapeutics is a relatively young field, and much remains to be discovered. It is to be hoped that as trial data accumulate they will demonstrate that these agents will improve overall glycemic control in those with type 2 diabetes. The possibility that they may also be able to affect the course of this devastating metabolic disorder should also be fully explored.
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PMID:Clinical management strategies for type 2 diabetes. 1821 46

Glucagon-like peptide-1 (GLP-1) may contribute to the decreased incretin effect characterizing type 2 diabetes. Multiple actions other than insulin secretion stimulation give to GLP-1 a highly desirable profile for an antidiabetic agent. To overcome the need for continuous infusion of the native compound, which is rapidly degraded by dimethyl-peptidyl-peptidase-IV (DPP-IV), analogues with low affinity for this protease have been developed. A second major strategy is represented by DPP-IV inhibitors that act to increase endogenous GLP-1. On the basis of the promising results in clinical trials, the incretin-based therapy may offer an useful option for diabetes management.
Curr Diabetes Rev 2007 Feb
PMID:Adapting the GLP-1-signaling system to the treatment of type 2 diabetes. 1822 Jun 52

Type II diabetes is a heterogeneous disease where environment and genetics are important factors for the expression of the disease. The high cost for treating complications of diabetes is a burden for public health systems and governments worldwide. Type II diabetes has been causing debilitation worldwide for many decades, and a single drug that safely treats the disease has yet to be discovered. Sulfonylureas, biguanides, alpha-glucosidase, meglitinides, DPP-4 inhibitors and thiazolidinediones are among the classes of oral hypoglycemic drugs available to treat Type II diabetes, but concerns exist regarding safety and efficacy of these drugs. In this article we present the pros and cons of the six classes and discuss some of the latest advances towards the development of new drugs for the treatment of Type II diabetes.
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PMID:Type 2 diabetes and oral antihyperglycemic drugs. 1822 Jul 63

Diabetes mellitus is a chronic metabolic disorder, characterized by glucose overproduction and glucose underutilization. Current therapy for T2DM includes drugs, like metformin, glitazones, sulphonyl ureas, etc. Extensive research has been carried out world wide on molecular targets for T2DM like PPARgamma, PTP1B, DPP-IV, GSK-3, cannabinoid receptor, fructose-bisphosphatases, beta3 adrenoceptor, etc. in the development of newer anti-diabetic agents. These therapeutic targets are quite important and most of them are suitable for in silico analysis. Hence, many molecular modeling and informatics studies like, molecular docking, pharmacophore mapping, 3D-QSAR, virtual screening, quantum chemical studies, and pharmacoinformatics like bioinformatics and chemoinformatics studies have been performed on the drugs/leads/targets associated with T2DM. Several of these in silico efforts are exemplary studies; the methodologies adopted in these studies can be emulated in many other therapeutic areas. A review of the rational approaches reported in designing anti-diabetic agents is presented in this article.
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PMID:Modeling and informatics in designing anti-diabetic agents. 1822 Jul 88

The state of prediabetes comprises two types of impairment of carbohydrate metabolism: impaired fasting glycemia and impaired glucose tolerance. According to International Diabetes Federation at present number of patients with prediabtes is almost 2 times greater than that of patients with diabetes. Risk of development of diabetes and cardiovascular complications in patients with prediabtes is 2 times higher than in persons with normal blood glucose level. Impaired glucose tolerance is also one of main components of metabolic syndrome. For prevention of risk of development of diabetes and cardiovascular complications besides life style changes it is necessary to influence insulin resistance and normalize carbohydrate metabolism. When life style changes are ineffective the use of antihyperglycemic drugs is essential. Antihyperglycemic preparations metformin, acarbose, thiazolidinediones do not affect function of pancreatic beta-cells and do not cause hypoglycaemia. This allows to use these drugs in patients without diabetes but having insulin resistance and prediabetes. Therapeutic effect of metformin and rosiglitazone is related to improvement of sensitivity to insulin in insulin dependent tissues, suppression of glyconeogenesis in the liver, and enhancement of pancreatic beta-cells function. Action of acarbose is based on local inhibition of intestinal enzyme alpha-glycosidase, what leads to diminishment of postprandial hyperglycemia peak. Results of DPP, STOP-NIDDM and DREAM trials have demonstrated high efficacy of antihyperglycemic preparations in prevention of type 2 diabetes.
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PMID:[Perspectives of the use of antihyperglycemic preparations in patients with metabolic syndrome and prediabetes]. 1826 Aug 85

Strong evidence exists demonstrating the benefits of tight glycemic control in type 1 and type 2 diabetes mellitus patients, but glycemic goals are not adequately achieved for many patients. Advancement in the knowledge surrounding the physiology of endogenous glucoregulatory peptide hormones, such as glucose-dependent insulinotropic polypeptide and glucagon-like peptide-1, has led to new therapeutic targets for the treatment of type 2 diabetes mellitus. Dipeptidyl peptidase-4 (DPP-4) inhibitors provide practitioners with a novel mechanism of action to use for combination therapies for the treatment of type 2 diabetes mellitus. This article, part 3 of a 3-part series, reviews the new class of medications known as DPP-4 inhibitors as well as discusses a future buccal insulin formulation, Oral-Lyn, on the horizon for the treatment of diabetes mellitus.
Diabetes Educ
PMID:Looking to the future: focus on DPP-4 inhibitors for the treatment of type 2 diabetes and emerging therapies. 1837 72


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