title: New developments in diabetes management: medications of the 21st century.
abstract: BACKGROUND
  Suboptimal blood glucose control among patients with type 2 diabetes continues to support the need for new pharmacologic approaches.
  
  
  OBJECTIVE
  The purpose of this commentary was to highlight newly available and soon-to-be available agents that are promising tools for targeting specific pathophysiologic pathways in the management of diabetes.
  
  
  METHODS
  Published evidence to support the application of novel incretin-based therapies, dipeptidyl peptidase (DPP)-4 inhibitors, sodium-glucose cotransporter (SGLT)-2 inhibitors, other oral agents and insulins for managing specific aspects of type 2 diabetes, as well as disadvantages associated with those novel medications, are discussed.
  
  
  RESULTS
  Several new glucagon-like peptide (GLP)-1 receptor agonists with different time frames of action, although each has unique advantages and disadvantages, have been through clinical trials. Examples of these are lixisenatide and albiglutide. Currently available DPP-4 inhibitor agents, important for inhibiting the breakdown of endogenous GLP-1, have not been associated with weight gain or hypoglycemia. SGLT-2 inhibitors, which do not depend on insulin secretion or insulin action, may be advantageous in that they appear to be broadly efficacious at all stages of diabetes. New insulin analogues, such as degludec and U-500, improve glycemic control without contributing to hypoglycemia.
  
  
  CONCLUSIONS
  Advances in pharmacologic options offer the promise of improving glycemic control for longer periods, with limited glycemic fluctuations, hypoglycemia, and weight gain. However, the effectiveness of these agents ultimately depends on their availability to providers managing the health care of patients at high risk for poor diabetes outcomes and patients' use of them as directed. Long-term effectiveness and safety trials are ongoing.
authors.affiliation: Section of Endocrinology, Tulane University Medical Center, New Orleans, Louisiana. Electronic address: vfonseca@tulane.edu.
authors.forename: Vivian A
authors.initials: VA
authors.lastname: Fonseca
mesh_terms: D001786:Blood Glucose; D003924:Diabetes Mellitus, Type 2 / Q000097:blood / Q000188:drug therapy*; D054873:Dipeptidyl-Peptidase IV Inhibitors / Q000494:pharmacology; D005260:Female; D052216:Glucagon-Like Peptide 1 / Q000031:analogs & derivatives; D006801:Humans; D007003:Hypoglycemia / Q000139:chemically induced; D007004:Hypoglycemic Agents / Q000627:therapeutic use*; D054795:Incretins / Q000627:therapeutic use; D007328:Insulin / Q000627:therapeutic use; D049528:Insulin, Long-Acting / Q000627:therapeutic use; D008297:Male; D010455:Peptides / Q000627:therapeutic use; D000067758:Glucagon-Like Peptide-2 Receptor
chemical_list: D001786:Blood Glucose; D054873:Dipeptidyl-Peptidase IV Inhibitors; D052216:Glucagon-Like Peptide 1; D007004:Hypoglycemic Agents; D054795:Incretins; D007328:Insulin; D049528:Insulin, Long-Acting; D010455:Peptides; C571886:insulin degludec; C479460:lixisenatide; D000067758:Glucagon-Like Peptide-2 Receptor
keywords: DPP-4 inhibitors; Diabetes Treatment; Glucagon-like Peptide 1; Incretins; Novel Insulins; Sodium -glucose co transporter 2 (SGLT2) inhibition