Chapter 8 Managing glycaemia: recently introduced and future therapies
Clifford J Bailey and
Caroline Day
- • Established blood glucose-lowering agents exert valuable effects in the management of type 2 diabetes, but they do not entirely normalize metabolic control: hence the need for additional therapies
- • New formulations of some established agents and single tablet ‘fixed-dose’ combinations offer improved efficacy with reduced side effects, and assist in reducing ‘pill burden’
- • Glucagon-like peptide-1 (GLP-1) receptor agonists, namely exenatide and liraglutide, are subcutaneously injected peptide analogues of GLP-1 that increase prandial insulin secretion, reduce glucagon secretion and facilitate weight loss
- • Inhibitors of the enzyme dipeptidyl peptidase-IV (DPP-4), known as gliptins (e.g. sitagliptin, vildagliptin and saxagliptin) are oral agents that prevent the degradation of endogenous GLP-1, providing a further means to enhance prandial insulin secretion
- • The dopamine D2 agonist bromocriptine, the bile sequestrant colesevelam, and the soluble amylin analogue pramlintide have received glucose-lowering indications in some countries outside of Europe
- • Potential new types of blood glucose-lowering agents in development include inhibitors of the renal sodium-glucose cotransporter-2 (SGLT2), activators of the glucose-phosphorylating enzyme glucokinase, and inhibitors of the glucocorticoid-activating enzyme 11β-hydroxysteroid dehydrogenase-1 (11βHSD1).
