Diabetes: A primer on new drug options

Over the past 20 years, the treatment armamentarium for diabetes has greatly expanded: 8 different classes of non-insulin drugs and 8 different types of insulin are now available. The newer classes of agents include disaccharidase inhibitors, thiazolidinediones, meglitinides, glucagonlike peptide analogs, and dipeptidyl peptidase IV inhibitors. These drugs offer advantages to certain patients when used as add-on (or first-line) therapy; however, metformin remains the preferred first-line oral agent. New long-acting insulin analogs provide more constant basal insulin coverage than neutral protamine Hagedorn (NPH) or lente insulin. Semisynthetic rapid-acting insulins help control prandial hyperglycemia with less risk of postprandial hypoglycemia than is seen with regular insulin. In addition to the many new pharmacological treatments for diabetes, the advent of continuous glucose monitoring permits relatively automated control of insulin pump administration.