Diabetes: New Drug Options and Old Choices

摘要

Over the past 20 years, the treatment armamentarium for diabetes has greatly expanded: There are now many different classes of non-insulin drugs and many types of both long-and short-acting insulin now available. The newer classes of agents include disaccharidase inhibitors, thiazolidinediones, meglitinides, glucagon-like peptide one analogs, and dipeptidyl peptidase IV inhibitors. These drugs offer advantages to certain patients when used as add-on (or first-line) therapy; however, metformin remains the preferred first-line oral agent. New long-acting insulin analogs provide more constant basal insulin coverage than neutral protamine.Hagedorn (NPH) insulin. Semisyn-thetic rapid-acting insulins help control prandial hyperglycemia with less risk of postprandial hypoglycemia than is seen with regular insulin, but the cost of analogs is much higher than for NPH or regular insulin. In addition to the many new pharmacological treatments for diabetes, the advent of continuous glucose monitoring permits relatively automated control of insulin pump administration. The evolution of diabetes treatment is continuing with active research on new agents including the sodium glucose cotransporter 2 inhibitors. New longer lasting preparations of insulin are also in sight, as is Technosphere inhaled insulin. As we welcome new treatment options, we must'be well aware that advances may carry risks. The sad saga of the thiazolidinediones serves as a somber.warning to be thoughtful in our use of new agents. At the same time, we should remember the significant advantages of our experience with the treatments that have proven beneficial for so many years.