Ghrelin and glucose homeostasis

► Ghrelin has direct effects on pancreatic islet function. ► Available data indicate the potential of ghrelin blockade as a means to prevent its diabetogenic effects. ► Direct antagonism of the receptor does not always have the desired effects, however, since it can cause increased body weight gain. ► Pharmacological suppression of the ghrelin/des-acyl ghrelin ratio by treatment with des-acyl ghrelin may also be a viable alternative approach which appears to improve insulin sensitivity. ► A promising new approach appears to be the blockade of GOAT activity.