Acta Diabetologica

, Volume 46, Issue 3, pp 173–181 | Cite as

Is the current therapeutic armamentarium in diabetes enough to control the epidemic and its consequences? What are the current shortcomings?

  • Dario GiuglianoEmail author
  • Eberhard Standl
  • Tina Vilsbøll
  • John Betteridge
  • Riccardo Bonadonna
  • Ian W. Campbell
  • Gerit-Holger Schernthaner
  • Bart Staels
  • Antonia Trichopoulou
  • Eduardo Farinaro
Review Article


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.


Antidiabetic drugs Diabetes mellitus, type 2 Disease management Beta-cell function Cardiovascular disease 



Action to Control Cardiovascular Risk in Diabetes




American Diabetes Association


Action in Diabetes and Vascular Disease: Preterax and Diamicron Modified Release Controlled Evaluation


Angiotensin-receptor blockers


Cardiovascular disease


Dipeptidyl peptidase-IV


European Association for the Study of Diabetes


European Society of Cardiology


European Society for Cardiovascular Prevention


Glucose-dependent insulinotropic peptide


Glucagon-like peptide-1


Left ventricular ejection fraction


Multiple Risk Factor Intervention Trial


United Kingdom Prospective Diabetes Study



The discussion on which this manuscript is based was supported by an unrestricted grant from Merck & Co. Writing support for this article was provided by Bioscript Stirling Ltd, UK, and funded by ESOCAP.

Conflict of interest statement

Dario Giugliano, Riccardo Bonadonna, Antonia Trichopoulou and Eduardo Farinaro have declared no conflicts of interest. Eberhard Standl has been an advisory board member for/received speaker’s fees from Novartis, Bayer, Takeda, MSD, Johnson & Johnson, Merck, Bristol-Myers Squibb, AstraZeneca and Solvay, as well as being a member of the data and safety monitoring boards for the PROactive, NAVIGATOR and ACE trials, and a member of the steering committee of the TECOS trial. Tina Vilsbøll has received fees for being a consultant, speaker and/or advisory board member for Eli Lilly, MannKind, MSD, Novartis and Novo Nordisk; she has also received scientific funding from MSD. John Betteridge has received honoraria for lectures and advisory boards from Takeda. Ian W. Campbell has received honoraria for lecturing and support to attend medical meetings from AstraZeneca, MSD, Merck Serono, Novo Nordisk, Sanofi-Aventis and Takeda. Gerit-Holger Schernthaner is a member of the Actos Strategic Advisory Board of Europe. Bart Staels has participated in advisory boards for Merck and Takeda Pharmaceuticals.


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Copyright information

© Springer-Verlag 2009

Authors and Affiliations

  • Dario Giugliano
    • 1
    Email author
  • Eberhard Standl
    • 2
  • Tina Vilsbøll
    • 3
  • John Betteridge
    • 4
  • Riccardo Bonadonna
    • 5
  • Ian W. Campbell
    • 6
  • Gerit-Holger Schernthaner
    • 7
  • Bart Staels
    • 8
  • Antonia Trichopoulou
    • 9
  • Eduardo Farinaro
    • 10
  1. 1.Division of Metabolic Diseases, Center of Excellence for Cardiovascular DiseasesSecond University of NaplesNaplesItaly
  2. 2.Munich Diabetes Research Institute at the Munich Helmholtz CenterMunichGermany
  3. 3.Department of Internal Medicine F, Gentofte HospitalUniversity of CopenhagenCopenhagenDenmark
  4. 4.Department of Medicine, Royal Free and University College Medical SchoolMiddlesex HospitalLondonUK
  5. 5.Department of Biomedical and Surgical SciencesUniversity of VeronaVeronaItaly
  6. 6.Department of Biological and Biomedical SciencesUniversity of St. AndrewsFifeUK
  7. 7.Department of Internal Medicine IIMedical University of ViennaViennaAustria
  8. 8.Department of AtherosclerosisU545 Inserm, University of Lille 2LilleFrance
  9. 9.Department of HygieneUniversity of Athens Medical SchoolAthensGreece
  10. 10.Department of Preventive Medical SciencesFederico II University of NaplesNaplesItaly

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