An update on pharmacotherapy for type 2 diabetes

Glucose lowering drugs have been available for clinical use for over the past 60 years or so with the last 2 decades seeing a significant number of new agents being developed making treatment increasingly complex and also somewhat controversial. This stems from the fact that while it is now known that patients with diabetes have an increased risk for cardiovascular disease and mortality there are mounting concerns with regards to the cardiovascular effects of certain antihyperglycemic agents leading to uncertainties when it comes to drug prescription. This has left many clinicians perplexed with respect to optimal strategies for management for management of such patients leading to many regulatory bodies to issue recommendations for antihyperglycimic therapy in adults with type 2 diabetes. These all uniformly advocate an individualised approach, keeping in mind each patients’ unique health profile (such as age and weight) and their cardiovascular risk factors vis-a-vie the specific attributes, side effects and adverse effects of each antihyperglycemic agent. This article will focus on the ten major categories of diabetic therapies looking specifically at their mode of action, safety profile as well as key trial data and where possible the long-term outcome studies for each class.peer-reviewe