PRESERVATION OF BETA-CELL FUNCTION IN TYPE 2 DIABETES

Objective: To review available data on preservation and potential improvement of beta-cell function in patients with type 2 diabetes mellitus (T2DM) with use of currently available strategies and agents. Methods: Using key words, we performed a MEDLINE search of the relevant literature published through 2009 regarding the effects of available agents on beta-cell function in humans with T2DM. Results: On the basis of current clinical data, no uniformly effective treatment for beta-cell preservation has been found. Lifestyle intervention and early intensive insulin therapy appear to have some preservative properties on beta-cell function. Glucagonlike peptide-1 agonists, dipeptidyl-peptidase-4 inhibitors, and thiazolidinediones result in maintenance and often improvement of beta-cell function during their active use; however, data on their ability to preserve beta-cell function when patients are not receiving active treatment are limited. Conclusion: The continuous loss of beta-cell mass and beta-cell function is a critical mechanism underlying the progressive deterioration of glycemic control in T2DM. In light of the projected increase in individuals at risk for developing T2DM, strategies and agents aimed at delaying or preventing the progression and inducing a remission of the disease are needed. Future research on this topic should include comparative efficacy trials with washout periods incorporating currently available and novel medications and strategies for preservation of beta cells. (Endocr Pract. 2010;16:1038-1055)