DRUG-TREATMENT OF NON-INSULIN-DEPENDENT DIABETES-MELLITUS IN THE 1990S - ACHIEVEMENTS AND FUTURE-DEVELOPMENTS

Non-insulin-dependent diabetes mellitus (NIDDM, type 2 diabetes) is a heterogeneous disease resulting from a dynamic interaction between def ects in insulin secretion and insulin action. There are various pharma cological approaches to improving glucose homeostasis, but those curre ntly used in clinical practice either do not succeed in restoring norm oglycaemia in most patients or fail after a variable period of time. F or glycaemic regulation, 4 classes of drugs are currently available: s ulphonylureas, biguanides (metformin), alpha-glucosidase inhibitors (a carbose) and insulin, each of which has a different mode and site of a ction. These standard pharmacological treatments may be used individua lly for certain types of patients, or may be combined in a stepwise fa shion to provide more ideal glycaemic control for most patients. Adjun ct treatments comprise a few pharmacological approaches which may help to improve glycaemic control by correcting some abnormalities frequen tly associated with NIDDM, such as obesity (serotoninergic anorectic a gents) and hyperlipidaemia (benfluorex). There is intensive pharmaceut ical research to find new drugs able to stimulate insulin secretion (n ew sulphonylurea or nonsulphonylurea derivatives, glucagonlike peptide -1), improve insulin action (thiazolidinediones, lipid interfering age nts, glucagon antagonists, vanadium compounds) or reduce carbohydrate absorption (miglitol, amylin analogues, glucagon-like peptide-1). Furt her studies should demonstrate the superiority of these new compounds over the standard antidiabetic agents as well as their optimal mode of administration; alone or in combination with currently available drug s.