Recent advances in the pharmacologic management of diabetes mellitus

Many advances in the pharmacologic management of diabetic patients have bee n made in recent years. Insulin lispro, the first rapidly acting subcutaneo us insulin, allows a more physiologic control of postprandial blood glucose and reduces the interval of hypoglycemic risk. The second-generation sulfo nylureas have virtually replaced the older drugs of this class, and repagli nide, a side chain of one of the sulfonylureas, also stimulates insulin rel ease from the pancreas. Metformin and acarbose improve glycemic control in type 2 diabetes without the risk for hypoglycemia. The fhiazolidinediones a re known as "insulin sensitizers" and attack the principal problem in type 2 diabetes, insulin resistance.