New developments in diabetes management: medications of the 21st century.
BACKGROUND
Suboptimal blood glucose control among patients with type 2 diabetes continues to support the need for new pharmacologic approaches.


OBJECTIVE
The purpose of this commentary was to highlight newly available and soon-to-be available agents that are promising tools for targeting specific pathophysiologic pathways in the management of diabetes.


METHODS
Published evidence to support the application of novel incretin-based therapies, dipeptidyl peptidase (DPP)-4 inhibitors, sodium-glucose cotransporter (SGLT)-2 inhibitors, other oral agents and insulins for managing specific aspects of type 2 diabetes, as well as disadvantages associated with those novel medications, are discussed.


RESULTS
Several new glucagon-like peptide (GLP)-1 receptor agonists with different time frames of action, although each has unique advantages and disadvantages, have been through clinical trials. Examples of these are lixisenatide and albiglutide. Currently available DPP-4 inhibitor agents, important for inhibiting the breakdown of endogenous GLP-1, have not been associated with weight gain or hypoglycemia. SGLT-2 inhibitors, which do not depend on insulin secretion or insulin action, may be advantageous in that they appear to be broadly efficacious at all stages of diabetes. New insulin analogues, such as degludec and U-500, improve glycemic control without contributing to hypoglycemia.


CONCLUSIONS
Advances in pharmacologic options offer the promise of improving glycemic control for longer periods, with limited glycemic fluctuations, hypoglycemia, and weight gain. However, the effectiveness of these agents ultimately depends on their availability to providers managing the health care of patients at high risk for poor diabetes outcomes and patients' use of them as directed. Long-term effectiveness and safety trials are ongoing.
['Fonseca|Vivian A|VA|']
D001786:Blood Glucose D003924:Diabetes Mellitus, Type 2 D054873:Dipeptidyl-Peptidase IV Inhibitors D005260:Female D052216:Glucagon-Like Peptide 1 D006801:Humans D007003:Hypoglycemia D007004:Hypoglycemic Agents D054795:Incretins D007328:Insulin D049528:Insulin, Long-Acting D008297:Male D010455:Peptides
DPP-4 inhibitors Diabetes Treatment Glucagon-like Peptide 1 Incretins Novel Insulins Sodium -glucose co transporter 2 (SGLT2) inhibition