TYPE 2 DIABETES MELLITUS

What evidence is there to support the prescribing of exenatide for adult's patients who are already prescribed insulin with type 2 diabetes mellitus?

What evidence is there to support the prescribing of exenatide for adult's patients who are already prescribed insulin with type 2 diabetes mellitus?

Introduction

Type 2 diabetes mellitus is a chronic and progressive disease that is frequently linked with long-term microvascular events that cause morbidity (neuropathy, nephropathy, retinopathy, micro-angiopathy) as well as macrovascular events that cause morbidity and mortality (coronary artery disease, stroke, peripheral vascular disease). Moreover, type 2 diabetes is the primary cause of end-stage renal disease worldwide. The life-threatening complications of this disease constitute a significant unmet medical need worldwide, particularly because the prevalence of type 2 diabetes has soared in recent years as a result of changing eating habits and lifestyles (Stamler, 1993, pp: 435).

The therapeutic goals for each patient with type 2 diabetes are maintenance of eug-lycemia and avoidance of long-term complications of diabetes, including prevention of cardiovascular events. Although several clinical trials in patients with type 2 diabetes have shown that some of these antidiabetic drugs decrease the risk of cardiovascular events, until recently there were no data correlating the use of an antidiabetic agent with the actual incidence of cardiovascular disease (CVD) in patients at high risk of fatal cardiovascular outcome (Stamler, 1993, pp: 437).

The paper discusses evidence factors to support the prescription of exenatide for adult patients who are already prescribed insulin with type 2 diabetes mellitus. To provide a context for this study may have great impact on the treatment of diabetes, we start with an overview of type 2 diabetes, including information about its increasing prevalence and associated comorbidities, particularly cardiovascular complications and treatments available. Then, we discuss the pharmacological profile of pioglitazone and design, results, and possible shortcomings of this breakthrough trial.

Discussion and Analysis

Type 2 Diabetes (also called insulin-independent diabetes mellitus or adult-onset diabetes) is a chronic and complex metabolic disorder characterized by insulin resistance (the ability of an attenuated response of peripheral tissues to insulin) and decreases the secretion of insulin from beta (ß) cells of pancreatic islets of Langerhans. Figure 1.1 shows this process and the complications of the disease. Insulin is an anabolic hormone that is needed for the main homeostatic regulation of the metabolism of carbohydrates, fats and proteins (Stamler, 1993, pp: 439).

More genetic defects that respond to environmental factors (e.g. obesity, physical inactivity), begin the process with diabetes in susceptible individuals. Insulin resistance in the liver, skeletal muscle and adipose tissue is the first indication of disease in prediabetic individuals. Researchers believe that insulin resistance in these tissues occurs at the level of insulin receptor and / or post-receptor insulin signaling pathways. In addition to insulin resistance, dysfunctional pancreatic ß cells are central to the pathophysiology of type 2 diabetes. The progressive loss of insulin secretion by ß cells, as a result of impaired glucose stimulated insulin secretion, places added stress of these cells to produce additional insulin to overcome the state of ...