Oral antihyperglycemic therapy for type 2 diabetes mellitus |
| |
| Authors: | Alice Y.Y. Cheng I. George Fantus |
| |
| Affiliation: | From the Department of Medicine, University of Toronto, and the Division of Endocrinology and Metabolism, Department of Medicine, St. Michael''s Hospital (Cheng), and the Division of Endocrinology and Metabolism, Department of Medicine, Mount Sinai Hospital and University Health Network and University of Toronto, and the Department of Physiology and Core Laboratory, Banting and Best Diabetes Centre, University of Toronto (Fantus), Toronto, Ont.
|
| |
| Abstract: | DIABETES MELLITUS IS A CHRONIC DISEASE that is growing in prevalence worldwide. Pharmacologic therapy is often necessary to achieve optimal glycemic control in the management of diabetes. Orally administered antihyperglycemic agents (OHAs) can be used either alone or in combination with other OHAs or insulin. The number of available OHAs has increased significantly in the last decade, which translates into more therapeutic options and complex decision-making for physicians. This review article is designed to help with these decisions. We review the mechanism of action, efficacy and side effects of the different classes of OHAs (α-glucosidase inhibitors, biguanides, insulin secretagogues, insulin sensitizers and intestinal lipase inhibitor) and discuss the current recommendations for their use.Diabetes mellitus is a chronic disease that is growing in prevalence worldwide.1 Canadian data from the National Diabetes Surveillance Strategy demonstrate a prevalence of 4.8% among adults, with the vast majority having type 2 diabetes.2With the growing elderly Canadian population, the rising prevalence of obesity and the alarming increase in childhood and adolescent type 2 diabetes, the burden of this disease will continue to grow. Aggressive glycemic control has been demonstrated to decrease microvascular3,4,5 and perhaps macrovascular6,7 complications, although the latter claim remains controversial. The Canadian Diabetes Association 2003 Clinical Practice Guidelines for the Prevention and Management of Diabetes in Canada8 recommends a target hemoglobin A1c concentration of 7.0% or less for all patients with diabetes and, for those in whom it can be safely achieved, a target hemoglobin A1c concentration in the normal range (usually ≤ 6.0%).8 Although nonpharmacologic therapy (e.g., diet, exercise and weight loss) remains a critical component in the treatment of diabetes, pharmacologic therapy is often necessary to achieve optimal glycemic control. Orally administered antihyperglycemic agents (OHAs) can be used either alone or in combination with other OHAs or insulin. The number of available OHAs has increased significantly in the last decade, which translates into more therapeutic options and complex decision-making. This article reviews the mechanism of action, efficacy and side effects of each OHA drug class (α-glucosidase inhibitors, biguanides, insulin secretagogues, insulin sensitizers and intestinal lipase inhibitor) and the current recommendations for their use. |
| |
| Keywords: | |
|
|
