Type 2 diabetes: Are current oral treatment options sufficient?

Summary:

Current treatment guidelines for type 2 diabetes mellitus (DM) focus on reducing blood glucose, which delays the onset and slows the progression of microvascular diabetic complications. Effects on macrovascular disease, however, are less pronounced. A multifactorial approach addressing cardiovascular risk factors as well as hyperglycaemia may be more appropriate for maximising macrovascular benefits of treatment. Current treatment options (sulphonylureas, metformin, glinides, acarbose, and thiazolidinediones) provide approximately equivalent blood glucose-lowering effects. Sulphonylureas and glinides increase insulin secretion, cause weight gain, and carry a risk of potentially fatal hypoglycaemia. Metformin has beneficial effects on insulin levels, insulin resistance, hepatic glucose production, and lipid profile, and therefore does address some known cardiovascular risk factors. However, its use is limited by tolerability issues. The thiazolidinediones have beneficial effects on insulin resistance and lipid profile, and potent antihyperglycaemic effects. Therefore, they also address cardiovascular risk factors. Early findings revealed distinguishable lipid effects among thiazolidinediones. Liver toxicity has not been associated with newer thiazolidinediones. A more `holistic' approach to the management of type 2 DM is needed that combines antihyperglycaemic measures with improvement of cardiovascular outcomes to address both macrovascular and microvascular complications. This paper reviews the therapeutic and adverse effects of all oral antidiabetic agents available for the treatment of type 2 DM.

Key words:

Macrovascular complications - thiazolidinediones - type 2 diabetes mellitus

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