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Sammanfattning

Adverse reactions, particularly hypoglyceamia, and the relatively modest effects of intensive glucose-lowering therapy on cardiovascular disease in recent large-scale trials have emphasized the need for a development of new therapeutic alternatives. The recently approved incretins have shown promising results but require daily injections. Therefore, intense efforts have been made to prolong the action or to find alternative routes of administration. Exenatide LAR and insulin glargine has recently been compared in a large RCT and shown similar effects on glucose control. Still, some concerns regarding risk of pancreatitis and thyroid cancers exist for GLP-1 agonists. Inhibitors of the sodium glucose cotransporter 2 have shown promising results as add-on therapy to metformin in a recent pivotal trial, with mild adverse effects. Genital infections may be a problem. A trial with an IL-1 receptor antagonist shows a new interesting concept with a putative action to preserve beta-cells. Glucokinase activators and 11_HSD1 inhibitors have shown promising results in phase II trials, but the risk of adverse phenomena with these drugs that interact with important metabolic and hormonal pathways have to be further investigated in humans.

MeSH