Is the current therapeutic armamentarium in diabetes enough to control the epidemic and its consequences? What are the current shortcomings?
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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.
KeywordsAntidiabetic 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
European Association for the Study of Diabetes
European Society of Cardiology
European Society for Cardiovascular Prevention
Glucose-dependent insulinotropic peptide
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.
- 1.International Diabetes Federation (2006) Diabetes atlas, 3rd edn. International Diabetes Federation, BrusselsGoogle Scholar
- 2.Rydén L, Standl E, Bartnik M et al (2007) Guidelines on diabetes, pre-diabetes, and cardiovascular diseases: executive summary. The Task Force on Diabetes and Cardiovascular Diseases of the European Society of Cardiology (ESC) and of the European Association for the Study of Diabetes (EASD). Eur Heart J 28:88–136PubMedCrossRefGoogle Scholar
- 9.Choose Control Survey Data (2006) Available from http://www.idf.org/home/index.cfm?node=295. Accessed 23 April 2008
- 15.Wiysonge CS, Bradley H, Mayosi BM et al (2007) Beta-blockers for hypertension. Cochrane Database Syst Rev Jan 24(1):CD002003Google Scholar
- 21.UK Prospective Diabetes Study Group (1998) Tight blood pressure control and risk of macrovascular and microvascular complications in type 2 diabetes: UKPDS 38. BMJ 317:703–713Google Scholar
- 24.Nathan DM, Buse JB, Davidson MB et al (2006) Management of hyperglycemia in type 2 diabetes: a consensus algorithm for the initiation and adjustment of therapy: a consensus statement from the American Diabetes Association and the European Association for the Study of Diabetes. Diabetes Care 29:1963–1972PubMedCrossRefGoogle Scholar
- 25.Nathan DM, Buse JB, Davidson MB et al (2008) Management of hyperglycemia in type 2 diabetes mellitus: a consensus algorithm for the initiation and adjustment of therapy: update regarding the thiazolidinediones: a consensus statement from the American Diabetes Association and the European Association for the Study of Diabetes. Diabetes Care 31:173–175PubMedCrossRefGoogle Scholar
- 28.Action to Control Cardiovascular Risk in Diabetes Study Group, Gerstein HC, Miller ME, Byington RP et al (2008) Effects of intensive glucose lowering in type 2 diabetes. N Engl J Med 358:2545–2559Google Scholar
- 29.ADVANCE Collaborative Group, Patel A, MacMahon S, Chalmers J et al (2008) Intensive blood glucose control and vascular outcomes in patients with type 2 diabetes. N Engl J Med 358:2560–2572Google Scholar
- 47.Nauck MA, Meininger G, Sheng D, Terranella L, Stein PP, Sitagliptin Study 024 Group (2007) Efficacy and safety of the dipeptidyl peptidase-4 inhibitor, sitagliptin, compared with the sulfonylurea, glipizide, in patients with type 2 diabetes inadequately controlled on metformin alone: a randomized, double-blind, non-inferiority trial. Diabetes Obes Metab 9:194–205PubMedCrossRefGoogle Scholar