Pharmacological management of diabetes: Recent progress and future perspective in daily drug treatment

Glycaemic control in Type I diabetes has been proven efficient in preventin g microvascular and neurological complications. The assumption that good co ntrol of hyperglycaemia may also have significant impact on alleviation of complications in Type 2 diabetes has gained growing support in recent years . Measures such as body weight reduction and exercise improve the metabolic defects, but pharmacological therapy is most frequently used. The sulphony lureas stimulate insulin secretion. Metformin and troglitazone increase glu cose disposal and decrease hepatic glucose output without causing hypoglyca emia. Acarbose helps to spread the dietary carbohydrate challenge to endoge nous insulin over time. These pharmacological treatments can improve blood glucose regulation in Type 2 diabetes patients. However, the key to strict glycaemic control with use of exogenous insulin lies in the creation of del ivery methods that emulate physiologic insulin secretion. Insulin lispro, a recombinant insulin analogue, is identical to human insulin except for the transposition of proline and lysine at positions 28 and 29 in the C-termin us of the B chain. Evidence suggests that patients perceive their quality o f life to be improved with insulin lispro when compared with regular human insulin, and that satisfaction with treatment is greater with the insulin a nalogue. Numerous new pharmacological approaches are under active investiga tion, with the aim of promoting insulin secretion, improving the action of insulin, or slowing carbohydrate absorption. With respect to continuous sub cutaneous insulin infusion therapy and implantable pumps, despite that this approach is not widely utilised, it appears to bring us as close to achiev ing glycaemic control as is feasible with current treatment approaches, How ever, general application of such technology requires significant improveme nts in several areas, such as improvement of patency of catheter, pump fail ures due to early battery depletion incidents, and pump miniaturisation. Fu ture perspective resides on insulin analogues with longer half-lives that w ould provide better basal insulin coverage in association with fast-acting analogues. PHARMACOL. THER. 81(1):31-51, 1999. (C) 1998 Elsevier Science In c.