Background. Remodeling of the endocrine pancreas, caused by the deleterious
effects of amylin as it is co-synthesized, co-packaged, and co-secreted wi
th insulin, gives clinicians and researchers cause to ponder.
Methods, A literature search was done, and relevant publications and texts
on amylin and islet amyloid polypeptide (IAPP) were reviewed.
Results, The mechanisms and clinical consequences attributed to the remodel
ing of the endocrine pancreas, along with proposals for reevaluating the me
thods of treating patients who have type 2 diabetes are illustrated and dis
cussed.
Conclusions, In addition to controlling the devastating effects of glucotox
icity, lipotoxicity and hypertension, we should consider the newer hypoglyc
emic agents with regard to their effects on the remodeling of the endocrine
pancreas. This remodeling results in structural and subsequent functional
changes, causing continued elevations of hemoglobin A(IG). Studies are indi
cated to determine whether amylin (IAPP) may be implicated in the remodelin
g of the arterial vessel wall, the glomerulus of the kidney, and the cardia
c interstitium.