Pharmacology and therapeutic implications of current drugs for type 2 diabetes mellitus

Research output: Contribution to journalReview articlepeer-review

Authors

External organisations

  • Centre of Endocrinology
  • Department of Diabetes and Endocrinology
  • Department of Geriatric Medicine, Heart of England NHS Foundation Trust, Solihull Hospital, Birmingham, UK.
  • Aston University

Abstract

Type 2 diabetes mellitus (T2DM) is a global epidemic that poses a major challenge to health-care systems. Improving metabolic control to approach normal glycaemia (where practical) greatly benefits long-term prognoses and justifies early, effective, sustained and safety-conscious intervention. Improvements in the understanding of the complex pathogenesis of T2DM have underpinned the development of glucose-lowering therapies with complementary mechanisms of action, which have expanded treatment options and facilitated individualized management strategies. Over the past decade, several new classes of glucose-lowering agents have been licensed, including glucagon-like peptide 1 receptor (GLP-1R) agonists, dipeptidyl peptidase 4 (DPP-4) inhibitors and sodium/glucose cotransporter 2 (SGLT2) inhibitors. These agents can be used individually or in combination with well-established treatments such as biguanides, sulfonylureas and thiazolidinediones. Although novel agents have potential advantages including low risk of hypoglycaemia and help with weight control, long-term safety has yet to be established. In this Review, we assess the pharmacokinetics, pharmacodynamics and safety profiles, including cardiovascular safety, of currently available therapies for management of hyperglycaemia in patients with T2DM within the context of disease pathogenesis and natural history. In addition, we briefly describe treatment algorithms for patients with T2DM and lessons from present therapies to inform the development of future therapies.

Details

Original languageEnglish
Pages (from-to)566-592
Number of pages27
JournalNature Reviews Endocrinology
Volume12
Issue number10
Early online date24 Jun 2016
Publication statusPublished - 1 Oct 2016

Keywords

  • Drug therapy , Mechanism of action , Pharmacodynamics , Pharmacokinetics , Type 2 diabetes