Oral agents in the management of type 2 diabetes mellitus

Despite exhaustive efforts to better manage patients with type 2 diabetes m ellitus (formerly known as non-insulin-dependent diabetes mellitus), attemp ts at maintaining near normal blood glucose levels in these patients remain s unsatisfactory. This continues to pose a real challenge to physicians as the prevalence of this disease in the United States continues to rise. Type 2 diabetes is defined as a syndrome characterized by insulin deficiency, i nsulin resistance and increased hepatic glucose output. Medications used to treat type 2 diabetes are designed to correct one or more of these metabol ic abnormalities. Currently, there are five distinct classes of hypoglycemi c agents available, each class displaying unique pharmacologic properties. These classes are the sulfonylureas, meglitinides, biguanides, thiazolidine diones and alpha-glucosidase inhibitors. In patients for whom diet and exer cise do not provide adequate glucose control therapy with a single oral age nt can be tried. When choosing an agent, it is prudent to consider both pat ient- and drug-specific characteristics. If adequate blood glucose control is not attained using a single oral agent, a combination of agents with dif ferent mechanisms of action may have additive therapeutic effects and resul t in better glycemic control.