TYPE 2 DIABETES – PATHOPHYSIOLOGY AND MEDICAMENTAL TREATMENT
Background: Diabetes mellitus, especially type 2, is one of the most common chronic diseases in the world today, and its prevalence is still increasing strongly. Working with prevention of diabetes is very important, but despite our best efforts, many will develop diabetes mellitus in the years to come. More effective medicines for diabetes treatment are needed, and various new treatment options are currently under investigations.
Aims: We wanted to do a review of today’s available diabetes medicines and of new ones that are currently under development. We wished to compare and find out if the new medicines offer any significant advantages over the traditional ones.
Methods: First we started by making an overview of diabetes mellitus type 2, including its prevalence in Norway and pathophysiology. Then we did a literature review based on articles we were able to find in the largest medical databases and publications, about today’s diabetes medicines and new ones under investigations.
Results: Type 2 diabetes treatment today consists in the beginning of weight reduction, diet changes and more physical activity, then with oral antidiabetic drugs, such as metformin, sulphonylurea, glinides and acarbose. A relatively new group of antidiabetic drug is glitazone. Glitazones are PPAR-agonists which also have other positive effects, such as regulation of dyslipidemia. When even oral antidiabetic drugs become insufficient, insulin treatment is indicated. A new way of insulin administration is by inhalation. Although a very promising concept, there are a lot of issues that need to be solved before inhaled insulin becomes a viable option. Another group of drugs under investigations is the incretin mimetics, which are hormones produced in the GI tract with antidiabetic effects.
Conclusion: Traditional antidiabetic drugs such as metformin is in our opinion still the safest and best choice unless contraindicated. Glinides work like sulphonylurea, but are much more expensive and therefore less used. Glitazones, PPARã-agonists, have been on the market for a while with proven effect, although they do not have any significant higher antidiabetic effect compared to metformin and are much more expensive. Pan-PPARáãä-agonists are also in development. Inhaled insulin and incretin mimetics are both promising new drug groups, but both still lack documentations. As for inhaled insulin, there are many other difficult issues that are yet to be solved.