Chapter

Managing glycaemia: recently introduced and future therapies

Clifford J Bailey and Caroline Day

in Type 2 Diabetes

Second edition

Published on behalf of Oxford University Press

Published in print May 2010 | ISBN: 9780199596171
Published online January 2012 | e-ISBN: 9780191739699 | DOI: http://dx.doi.org/10.1093/med/9780199596171.003.0087

Series: Oxford Diabetes Library

Managing glycaemia: recently introduced and future therapies

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• 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).

Chapter.  4813 words.  Illustrated.

Subjects: Endocrinology and Diabetes

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