Open Access
Article
Current strategies for the inhibition of hepatic glucose production in type 2 diabetes
Dale S Edgerton1,Kathryn M S Johnson1,Alan D Cherrington1
1
Department of Molecular Physiology and Biophysics, Vanderbilt University Medical Center, Nashville TN, 37232-0615, USA. dale.edgerton@vanderbilt.edu
DOI: 10.2741/3301 Volume 14 Issue 3, pp.1169-1181
Published: 01 January 2009
(This article belongs to the Special Issue New therapeutic approaches for type 2 diabetes)
Abstract

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.

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Dale S Edgerton, Kathryn M S Johnson, Alan D Cherrington. Current strategies for the inhibition of hepatic glucose production in type 2 diabetes. Frontiers in Bioscience-Landmark. 2009. 14(3); 1169-1181.