Our publication on new therapies in the management of type 2 diabetes mellitus (T2DM) is published today [1]. Emerging therapies for T2DM are many and varied in their approach, with several recent advances now questioned because of an adverse longer-term side-effect profile. This review describes some of the major recent and prospective developments.

Traditional therapies for T2DM have concentrated on correcting pancreatic β-cell failure and/or insulin resistance. Despite the many therapies using a variety of mechanisms of action, T2DM remains a progressive disease that has a significant impact on patient morbidity and mortality. New approaches to the control of blood glucose are required that are cognisant of the metabolic comorbities of weight gain, hypertension, dyslipidaemia and the progression of diabetes through further reduction in β-cell mass. Our article reviews several new agents that may offer novel means of restoring normoglycaemia and maintaining a metabolic balance in patients with type 2 diabetes. Starting with metabolic (bariatric) surgery, therapies are presented in order of their stage of development.

Hypoglycaemia in T2DM is predominantly an issue for patients who use insulin or secretagogues, such as sulphonylureas and the glinides (nateglinide (Starlix) and repaglinide (Prandin)). The latter largely cause hypoglycaemia because of their rapid short duration of action in the post-prandial phase. More recent therapeutic developments of novel agents suggest a considerably lower risk of hypoglycaemia. Bariatric surgery does offer a risk of hypoglycaemia and caution is still important when combinations of hypoglycaemics are prescribed. The UK guidelines suggest that when there is concern about hypoglycaemia, add-on therapy to metformin could include a DPP-4 inhibitor or pioglitazone, in preference to sulphonylureas [2].

The article concludes that current guidance on diabetes management places focus on individualizing therapy with the emphasis on an alliance between patient and prescriber. Newer therapies follow our increasing understanding of diabetes and provide a greater range of approaches to a bespoke service to lower glucose and address concomitant medical conditions.

References

1. Hardman TC. And Dubrey SW. New therapies in the management of type 2 diabetes mellitus. Br J Hosp Med (Lond). 2013 Apr;74(4):202-7.
2. National Collaborating Centre for Chronic Conditions (UK). Type 2 Diabetes: National Clinical Guideline for Management in Primary and Secondary Care (Update). London: Royal College of Physicians (UK); 2008. PMID: 21678628.