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J Diabetes Investig. 2024;15(6):669-683.

Pancreatic beta-cell mass and function and therapeutic implications of using antidiabetic medications in type 2 diabetes.

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제1저자 문준호, 최훈지 · 교신저자 임수

PMID 38676410 PMC11143426 DOI 10.1111/jdi.14221 IF 3.6 내분비대사내과
소속 (3)
  1. Department of Internal Medicine, Seoul National University College of Medicine, Seongnam, South Korea.
  2. Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, South Korea.
  3. Department of Internal Medicine, Hallym University Dongtan Sacred Heart Hospital, Hwaseong, South Korea.

Abstract

Nowadays, the focus of diabetes treatment has switched from lowering the glucose level to preserving glycemic homeostasis and slowing the disease progression. The main pathophysiology of both type 1 diabetes and long-standing type 2 diabetes is pancreatic β-cell mass loss and dysfunction. According to recent research, human pancreatic β-cells possess the ability to proliferate in response to elevated insulin demands. It has been demonstrated that in insulin-resistant conditions in humans, such as obesity or pregnancy, the β-cell mass increases. This ability could be helpful in developing novel treatment approaches to restore a functional β-cell mass. Treatment strategies aimed at boosting β-cell function and mass may be a useful tool for managing diabetes mellitus and stopping its progression. This review outlines the processes of β-cell failure and detail the many β-cell abnormalities that manifest in people with diabetes mellitus. We also go over standard techniques for determining the mass and function of β-cells. Lastly, we provide the therapeutic implications of utilizing antidiabetic drugs in controlling the mass and function of pancreatic β-cells.

© 2024 The Authors. Journal of Diabetes Investigation published by Asian Association for the Study of Diabetes (AASD) and John Wiley & Sons Australia, Ltd.

Keywords

Antidiabetic drugsInsulin secretionPancreatic β‐cell

Figures

Figure 1
Figure 1 Mechanisms of GLP‐1 mediated β‐cell functional enhancement and preservation. Activation of the glucagon‐like peptide‐1 (GLP‐1) receptor on β‐cells by endogenous GLP‐1, released from enteroendocrine L cells, leads to an increase in intracellular cyclic adenosine monophosphate (cAMP) levels. This rise in cAMP activates protein kinase A (PKA) and Exchange protein activated by cAMP (Epac), thereby enhancing insulin gene transcription mediated by the transcription factor pancreatic and duodenal homeobox 1 (PDX‐1), increasing insulin exocytosis, and promoting β‐cell proliferation. Additionally, this signaling pathway mitigates endoplasmic reticulum (ER) stress, contributing to β‐cell survival. Glucose stimulates GLP‐1 secretion through glucose transporter 2 (GLUT2)‐mediated uptake and the closure of K ATP channels, as well as the activation of enzymes involved in β‐cell glucose metabolism, thus contributing to GLP‐1's glucose‐dependent effects on insulin secretion. The figure further illustrates the downstream impact of PKA activation on the phosphorylation of cAMP response element‐binding protein (CREB) and the subsequent expression of insulin receptor substrate‐2 (IRS‐2), amplifying the insulin signaling cascade (created with BioRender.com).
Figure 2
Figure 2 Mechanisms of thiazolidinedione action on pancreatic β‐cells. Thiazolidinediones (TZDs), by activating the peroxisome proliferator‐activated receptor‐gamma (PPARγ) receptor, upregulate the transcription of genes that enhance insulin sensitivity and β‐cell function. PPARγ activation leads to increased levels of transcription factor pancreas duodenum homeobox‐1 (PDX‐1), which is responsible for insulin gene transcription, and also elevates glucose transporter 2 (GLUT2) and glucokinase expression, facilitating glucose metabolism. Furthermore, TZDs engage G protein‐coupled receptor 40 (GPR40) to enhance insulin transcription in response to free fatty acid (FFA). The signaling cascades initiated by TZDs, including extracellular signal‐regulated kinase (ERK) 1/2 and p38 mitogen‐activated protein kinase (MAPK) pathways, are depicted, highlighting their roles in β‐cell survival and plasticity, as well as reducing oxidative stress and endoplasmic reticulum (ER) stress to preserve β‐cell functionality (created with BioRender.com).

그림 출처: PubMed Central 공개 논문 (PMC11143426)

그 밖의 정보
출판 형태
Journal Article, Review
저널
Journal of diabetes investigation · eISSN 2040-1124
전자 출판
2024-04-27
MeSH
Humans · Diabetes Mellitus, Type 2* / drug therapy / metabolism · Insulin-Secreting Cells* / drug effects / metabolism / physiology · Hypoglycemic Agents* / therapeutic use · Animals
Substances
Hypoglycemic Agents
연구비
National Research Foundation of Korea 2021R1C1C1009875
참고문헌
153편