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Diabetes Mellitus: Metabolic Syndrome and Role of Incretins!

 METABOLIC SYNDROME AND INCRETIN EFFECT

METABOLIC SYNDROME:

"Insulin resistance has been associated with a number of other cardiovascular risks, including Abdominal obesity, Hypertension, Dyslipidemia, Hypercoagulation, and Hyperinsulinemia. The clustering of these risk factors has been termed as Metabolic syndrome."

The most widely used criteria to define metabolic syndrome were established by the National Cholesterol Education Program Adult Treatment Panel III Guidelines.



INCRETIN EFFECT

  • Incretins: are a group pf metabolic hormone that stimulate a decrease in blood Glucose levels.
  • Incretin hormones are: GLP-1, GIP.
  • Incretins are gut hormones that are secreted from entero-endocrine cells into blood within minutes after eating (present in GIT, Stomach, and Pancreas).
  • A great deal of research is occurring today to develop compounds that enhance the incretin effect, either by mimicking its action or y enabling incretin hormones, to remain physiologically active for longer periods of time.

As early as the late 1960s, Perley and others observed that insulins response to oral glucose exceeded that of intravenous glucose administration. It was conducted that factors in the gut, or incretins affected the release of insulin after a meal is consumed.

  • When nutrients enter the stomach and intestine, incretin hormones are released which stimulates Insulin secretion. 
  • GLP-1 & GIP are two major incretin hormones; with GLP-1 being studied the most.

GLP-1 is secreted by the L-cells of the ileum and colon primarily. GLP-1 secretion is caused by the endocrine and neural signals started when nutrients enter the gastrointestinal tract. A glucose dependent release if insulin occurs, and the dipeptidyl peptidase (DDP-4) enzyme cleaves GLP-1 rapidly to an inactive metabolite. Other glucose lowering effects of GLP-1 include suppression of glucagon, slowing gastric emptying, and increasing satiety.

GIP is secreted by the K-cells.

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