Peter Salgo, MD, notes that type 2 diabetes mellitus (T2DM) is associated with multiple metabolic defects. Traditional agents (eg, metformin, TZDs, and sulfonylureas) target insulin production and sensitivity. Agents with novel mechanisms of action are now available for T2DM, including agents that target the incretin system and agents that affect renal glucose handling. Characteristics of the various drugs may make them more suitable for individual patients.
Kari Uusinarkaus, MD, FAAFP, FNLA, comments that glucagon-like peptide agents are a good adjunct to metformin treatment because they reduce weight in patients while improving glycated hemoglobin levels. For this reason, this treatment option is often preferred by patients.
Yehuda Handelsman, MD, FACP, FACE, FNLA, describes safety considerations regarding the newer agents, including increases in risk for acute pancreatitis and heart disease, and use in patients with renal impairment.
Jeffrey D. Dunn, PharmD, MBA, discusses the costs of emerging diabetes treatment options. Dr Dunn and Maria Lopes, MD, MS, stress the importance of individualizing treatment and taking into account both efficacy and cost when treating patients with T2DM.