Summary and Conclusions
Type 2 diabetes is a progressive disease that is a growing health problem.
Several classes of drug are available to treat the condition, many of which
have a long history of use.
Some of the earlier drugs have known side
effects that limit their use in certain patient populations.
For example,
sulfonylureas can cause weight increase and hypoglycemia and are not
advised in patients with advanced liver or kidney disease; rapid-acting
variants of this class appear to cause fewer side effects, but are not as well
studied. Metformin is part of a widely prescribed class of drugs, but may
have GI side effects in a significant percentage of patients.
It also may
have a rare risk for lactic acidosis, and may be contraindicated in patients
with cardiac or respiratory insufficiency.
TZDs have a very slow onset of
action and have an attendant risk for fluid retention.
There is also some
concern about possible cardiovascular effects such as aggrevation of
congestive heart failure. Incretin-based therapies are the newest additions
to the antidiabetic fold, and offer the promise of controlling blood glucose
through stimulation of the pancreatic β cells. The incretin mimetic
exenatide mimics human GLP-1 but is not degraded by DPP-4, thus
extending its half-life. It has so far been shown to reduce HbA1c and
stimulate weight loss without serious adverse events.
It is also non-inferior
to many other available antidiabetic drugs, and may even be diseasemodifying.
DPP-4 inhibitors have also had positive results, although they
are not associated with weight loss and have not yet been compared with
either insulin or exenatide.
Nevertheless, the addition of these new drugs
brings new hope to those with type 2 diabetes, and more studies will help
reveal the best patient populations for each one.
Summary and Conclusions
Type 2 diabetes is a progressive disease that is a growing health problem.
Several classes of drug are available to treat the condition, many of which
have a long history of use.
Some of the earlier drugs have known side
effects that limit their use in certain patient populations.
For example,
sulfonylureas can cause weight increase and hypoglycemia and are not
advised in patients with advanced liver or kidney disease; rapid-acting
variants of this class appear to cause fewer side effects, but are not as well
studied. Metformin is part of a widely prescribed class of drugs, but may
have GI side effects in a significant percentage of patients.
It also may
have a rare risk for lactic acidosis, and may be contraindicated in patients
with cardiac or respiratory insufficiency.
TZDs have a very slow onset of
action and have an attendant risk for fluid retention.
There is also some
concern about possible cardiovascular effects such as aggrevation of
congestive heart failure. Incretin-based therapies are the newest additions
to the antidiabetic fold, and offer the promise of controlling blood glucose
through stimulation of the pancreatic β cells. The incretin mimetic
exenatide mimics human GLP-1 but is not degraded by DPP-4, thus
extending its half-life. It has so far been shown to reduce HbA1c and
stimulate weight loss without serious adverse events.
It is also non-inferior
to many other available antidiabetic drugs, and may even be diseasemodifying.
DPP-4 inhibitors have also had positive results, although they
are not associated with weight loss and have not yet been compared with
either insulin or exenatide.
Nevertheless, the addition of these new drugs
brings new hope to those with type 2 diabetes, and more studies will help
reveal the best patient populations for each one.
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