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		Literature Compendium

Current Concepts in Type 2 Diabetes

Volume 2
The Appropriate Application of Oral Pharmacological Therapy, Non-Insulin Injectable Agents, and Insulin in the Management of Type 2 Diabetes

Introduction From the Co-Editors

Jaime A. Davidson
Alistair Emslie-Smith

This compendium is the second in a series of 3 volumes that present the foundational literature on fundamental understandings of Type 2 diabetes. Articles are reprinted in their entirety with commentary from the editors.* It is our hope that the reader will review the commentaries and study the literature to gain a better understanding of the importance of treating Type 2 diabetes and reducing the complications of this devastating disease.

Type 2 diabetes is a chronic condition requiring continual medical care and education in order to prevent acute complications and reduce the risk of long-term medical problems. In the progression to Type 2 diabetes, pancreatic β-cells respond at first by increasing their insulin output in an attempt to meet the demand. Despite the resulting hyperinsulinaemia, the hormone supply is insufficient to produce glycaemic control. Over time, β-cell function actually declines. Hyperglycaemia develops gradually, later followed by a rise in fasting plasma glucose levels. Complications, including macrovascular and microvascular changes, often begin well in advance of the clinical diagnosis of Type 2 diabetes.

Pharmacological therapy, in addition to lifestyle modification, is a critical component of care. The pharmacological therapy of Type 2 diabetes has evolved considerably in the last decade. The clinician now has a wide and growing variety of drug classes available, including the second-generation sulfonylureas, the meglitinides nateglinide and repaglinide, the thiazolidinediones pioglitazone and rosiglitazone, the biguanide metformin, the α-glucosidase inhibitors acarbose and miglitol, the glucagon-like peptide-1 receptor agonist exenatide and others currently in development, the dipeptidyl peptidase-4 inhibitors sitagliptin and vildagliptin and others currently in development, various insulin analogues, and various combination products. In addition, the developmental pipeline is rich with molecules in new drug classes, including protein kinase C-β inhibitors, sodium-glucose transport protein inhibitors, 11β-hydroxysteroid dehydrogenase Type 1 inhibitors, endocannabinoid system modulators, gluconeogenesis inhibitors, glucokinase activators, and aldose reductase inhibitors.

In order to negotiate the ever-expanding armamentarium of anti-hyperglycaemic agents, particularly with regard to the treatment of individuals with Type 2 diabetes, it is important to recognize the appropriate application of oral pharmacological therapy, non-insulin injectable agents, and various formulations of insulin.

This compendium presents key literature related to current management guidelines for Type 2 diabetes and currently available anti-hyperglycaemic agents. Chapter 1 presents an overview of evidence-based management guidelines issued by key organizations, including the American Diabetes Association in conjunction with the European Association for the Study of Diabetes, the International Diabetes Federation, and the American College of Endocrinology in conjunction with the American Association of Clinical Endocrinologists. The following 3 chapters focus on important issues related to key classes of drugs used in the treatment of individuals with Type 2 diabetes: metformin, insulin secretagogues, and insulin sensitizers (Chapter 2), incretin-based therapies (Chapter 3), and insulins (Chapter 4). As described in Chapter 4, use of insulin therapy in individuals with Type 2 diabetes is presently sub-optimal, and recent efforts have focused on increasing awareness of the benefits of insulin in this patient population.

*Note: articles are reprinted in their entirety in the printed version of the compendium. If you would like to be contacted when the printed volume is available, please e-mail WorldWIDE at worldwide@worldwidediabetes.org.

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The Literature Compendium is funded by an educational grant from Pfizer Inc.

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