Executive Editor Rattan Juneja, MBBS, MD, MRCP Associate Professor of Clinical Medicine Division of Endocrinology Medical Director Indiana University Diabetes Center IUSM, Indianapolis, Indiana
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Professor Juneja's Welcome Address

I’d like to welcome you all to the sixth annual Diabetes Update. We are in our sixth year. And this year we decided to cover the topic of the islets in Type 2. Surprise. Why in Type 2 diabetes and the islets?

Well, there were two recent studies that sparked this interest, because we are all familiar with the Diabetes Prevention Program, that you could prevent the occurrence of diabetes by a diet and exercise alone. And then came along two studies with thiazolidinediones, rosiglitazone, both of them. First one was DREAM, looked at the prediabetes patient. And then was ADOPT that looked at the newly diagnosed diabetes patient. And they showed that you can prevent the beta cell, potentially, from failing as quickly as we have seen with other medications that, you know, will result in much earlier failure of the beta cell.

So, the question really is being asked now is, can you preserve beta cells so that you do not have to go on insulin in the long term, and that’s why this topic.

This meeting is very important, because the understanding of diabetes for all of us is changing very, very quickly. Every year there is new data that’s coming out that is challenging preexisting conceptions about how this condition needs to be treated. And every year, new medications are being launched. Our understanding is changing. And therefore, we felt that to get this knowledge out into the community, this would be the best forum to try and bring all the new research out and talk about new medications and what their role is in the treatment of diabetes.

Our objective of the meeting today is really to cover a certain series of areas. Most importantly, what we would like people to go home with as a message is that we are trying to treat diabetes today like we’ve been treating rheumatoid arthritis, say 20 years ago. We are treating the pain of diabetes, just the glucose of diabetes.

What is causing the glucose to go up? I think the primary thing that we’re going to try to focus on is, why is the glucose going up, and how do we prevent the glucose from going up? So, that would be one main objective of our understanding today.

As we dig deeper into the reasons for why glucose goes up, we have to start looking not just at the beta cell, as we’ve done for so many years, but we have to look at the islet as an entity. And the islet has more cells than the beta cell. It has the alpha cell, which produces glucagon. And now, we’re beginning to understand that it could be a bihormonal disorder that we need to address. Of course, added to this is insulin resistance and obesity, which is compounding the problem.

So, we’re going to try to touch on all of these areas today.