JOE DOUPE LECTURE: Emerging Strategies for the Preservation of Pancreatic Beta-cell Function in early Type 2 Diabetes

Abstract

A fundamental problem in the clinical management of type 2 diabetes is the inability to prevent the ongoing deterioration of pancreatic beta-cell function over time that underlies the chronic progressive nature of this condition. Importantly, beta-cell dysfunction has both reversible and irreversible components. Furthermore, the amelioration of reversible beta-cell dysfunction through the early institution of short-term insulin-based therapy has emerged as a strategy that can yield temporary remission of type 2 diabetes. In this context, we have forwarded a novel therapeutic paradigm consisting of initial induction therapy to improve beta-cell function early in the course of diabetes followed by maintenance therapy aimed at preserving this beneficial beta-cell effect. Ultimately, this approach may yield an optimized therapeutic strategy for the durable preservation of beta-cell function and consequent modification of the natural history of type 2 diabetes. JOE DOUPE AWARD LECTURE

Type 2 diabetes after gestational diabetes: Can the progression be prevented?

“…Although most women with gestational diabetes appear to be “normal” post‐partum, with normal glucose tolerance, most have already started the decline in beta‐cell function, so characteristic of the progression to type 2 diabetes . Therefore, the key to prevention is to stop this inexorable beta‐cell decline and, at the same time, try to reverse the beta‐cell dysfunction while it may still be reversible . This means prevention has to start early.…”

“…11 Therefore, the key to prevention is to stop this inexorable beta-cell decline and, at the same time, try to reverse the beta-cell dysfunction while it may still be reversible. 12 This means prevention has to start early. For this reason, women with gestational diabetes, who are clearly early in their disease progression, with potentially modifiable beta-cell function, are excellent candidates.…”