Association of Diabetes Care & Education Specialists

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The Ominous Octet -- A presentation to remember

Mar 30, 2012

Dr. Ralph DeFronzo was the speaker at yesterday's Grand Rounds. If you ever get a chance to listen to one of his presentations, try to attend. The man obviously "gets it" when it comes to diabetes. He shared with us that a recent grant was approved and he is funded by the NIH for another 5 years. That makes him the longest continuously funded diabetes researchers in the world! At the end of this grant he will have 42 continuous years of NIH funding. 

But this is not a tribute to Dr. D (as he is called around here) but I wanted to share with you a brief synopsis of his lecture.  For those of you who attended the 2008 ADA when Dr. D presented the Banting Lecture, it will sound familiar. 

His presentation was on the Ominous Octet.  Remember back, 20-25 years ago when all we worried about was the pancreas when treating diabetes?  The only oral medication we had were the sulfonylureas to squeeze the pancreas just a little harder to get out every last drop of insulin? 

Prior to that, of course, we had insulin but no one wanted to take shots each day. We now had new and improved diabetes pills. According to stories I have read, it soon became apparent that the new pills were not all that they were expected to be.  People with diabetes were still going blind and losing their limbs.  Another issue of course was lack of SMBG – urine testing was not very reliable nor accurate – but this is a medication story.

Soon it was recognized that the liver played a part in the diabetes story and contributed to elevated glucose when people were not eating.  Along came biguanides or metformin.   When it was noted that the actual muscle cells played a role and were often resistant to the insulin – whether endogenous or exogenous – TZDs came to the rescue – all be it, not without a few bumps in their road.  

Over the last 10-12 years a flurry of activity has occurred in diabetes research and the development of new drugs and therapies.  The GI tract was introduced as an endocrine organ secreting hormones in response to food.  Some claim to have known about this for years but without any real treatment options there was not much they could do. Then incretin therapy hit the scene.  Now we felt we could move forward in treating diabetes. More recently the brain, adipose tissue, alpha cells and kidney have all been identified as major players in diabetes management and control.

So let's quickly review the ominous octet – the beta cells of the pancreas, the liver, muscle cells, the gut, the brain, adipose cells, the kidney, and malfunctioning of the alpha cells causing hyperglucagonemia all contribute to the elevated glucoses of diabetes.

As one physician said recently – Diabetes used to be so easy.  We've come a long way.

For more information, just “Google” Ralph DeFronzo Banting Lecture for the entire article.


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  1. Oct 02, 2012

    How exciting to step out of the box and see how complicated this disease is-
  2. Mar 31, 2012

    Regarding High Fructose Corn Syrup & Chocolate Milk in Schools- a lot written lately about this controversy...see attached CNN recent short segment. (

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