Is the current therapeutic armamentarium in diabetes enough to control the epidemic and its consequences? What are the current shortcomings?
The prevalence of diabetes is expected to rise together with an increase in morbidity and a reduction in life expectancy. A leading cause of death is cardiovascular disease, and hypertension and diabetes are additive risk factors for this complication. Selected treatment options should neither increase cardiovascular risk in patients with diabetes, nor increase risk of hyperglycaemia in patients with hypertension. The efficacy of present antihyperglycaemic agents is limited and new therapies, such as incretin-targeted agents, are under development. Even though most patients do not achieve glycated haemoglobin targets, trial data show that such interventions reduce the incidence of macrovascular events; however, intensive lowering may be detrimental in patients with existing cardiovascular disease. Currently available oral drugs do not address the key driver of type 2 diabetes--loss of functional beta-cell mass. In the future, new oral treatments must improve this, whilst providing durable blood glucose control and long-term tolerability.
Giugliano
Dario
D
Division of Metabolic Diseases, Center of Excellence for Cardiovascular Diseases, Second University of Naples, Piazza Miraglia, 80138, Naples, Italy. dario.giugliano@unina2.it
Standl
Eberhard
E
Vilsbøll
Tina
T
Betteridge
John
J
Bonadonna
Riccardo
R
Campbell
Ian W
IW
Schernthaner
Gerit-Holger
GH
Staels
Bart
B
Trichopoulou
Antonia
A
Farinaro
Eduardo
E
D003920:Diabetes Mellitus / Q000453:epidemiology; D003924:Diabetes Mellitus, Type 2 / Q000188:drug therapy / Q000453:epidemiology* / Q000628:therapy*; D004196:Disease Outbreaks / Q000517:prevention & control*; D005260:Female; D005749:Gastric Inhibitory Polypeptide / Q000494:pharmacology / Q000627:therapeutic use; D052216:Glucagon-Like Peptide 1 / Q000494:pharmacology / Q000627:therapeutic use; D006801:Humans; D006943:Hyperglycemia / Q000188:drug therapy; D006973:Hypertension / Q000150:complications / Q000453:epidemiology / Q000628:therapy; D007004:Hypoglycemic Agents / Q000494:pharmacology / Q000627:therapeutic use; D054795:Incretins / Q000494:pharmacology / Q000627:therapeutic use; D008297:Male
D007004:Hypoglycemic Agents; D054795:Incretins; D005749:Gastric Inhibitory Polypeptide; D052216:Glucagon-Like Peptide 1