New treatments for type 2 diabetes – what is on the horizon?

Worldwide, more than half the people with type 2 diabetes have blood glucose concentrations that are too high, leading to a greater risk of complications. This is partly because many existing treatments have limitations. metformin, for example, usually the first drug recommended if lifestyle changes are not sufficient to control blood glucose, may cause nausea and stomach upset, and cannot be given to people with kidney failure; sulphonylureas may cause weight gain and hypoglycaemia; and pioglitazone has been associated with weight gain, fluid retention, heart failure, bone fractures and bladder cancer.

New drugs have become available in the last few years include dpp-4 inhibitors, such as sitagliptin, saxagliptin and linagliptin. The injectable Glp-1 analogues, such as exenatide and liraglutide, are a significant advance as they have a lower risk of hypoglycaemia and weight gain. however, blood glucose concentrations tend to rise over time in type 2 diabetes, despite drug therapies, so people need additional treatments the longer they have had the condition – many eventually needing insulin.

Therefore, new treatments that might help to overcome some of these problems, particularly weight gain and hypoglycaemia, both of which also are a problem with insulin treatment and loss of insulin secretion over time, are desirable. here, John wilding reviews some of the latest research into new medicines for type 2 diabetes, focusing on drugs that might become available in the next few years.