J Korean Med Assoc.  2017 Dec;60(12):992-997. 10.5124/jkma.2017.60.12.992.

New anti-diabetic agents

• Kim DM

• KMID: 2397869
• DOI: http://doi.org/10.5124/jkma.2017.60.12.992

Abstract

Diabetes mellitus is characterized by hyperglycemia due to insulin deficiency and/or insulin resistance. Cardiovascular disease (CVD) is a major comorbidity of type 2 diabetes mellitus, and is the most common cause of death in people with diabetes mellitus. Several clinical trials have addressed the long-term effects of near-normoglycemia on CVD, but did not find evidence of an effect. However, some recent clinical trials of sodium glucose cotransporter 2 inhibitors (EMPA-REG [Empagliflozin Cardiovascular Outcomes and Mortality in Type 2 Diabetes Trial], CANVAS [Canagliflozin Cardiovascular Assessment Study]) or glucagon-like peptide-1 agonists (LEADER [Liraglutide Effect and Action in Diabetes: Evaluation of Cardiovascular Outcome Results-A Long Term Evaluation], SUSTAIN-6 [Trial to Evaluate Cardiovascular and Other Long-term Outcomes with Semaglutide in Subjects with Type 2 Diabetes]) showed very promising results regarding the prevention of CVD. In this review, I discuss some of these new anti-diabetic agents and present clinical information regarding these drugs.

Keyword

Diabetes mellitus, type 2; Sodium glucose cotransporter 2 inhibitors; Glucagon-like peptide-1 receptor agonists

MeSH Terms

Cardiovascular Diseases
Cause of Death
Comorbidity
Diabetes Mellitus
Diabetes Mellitus, Type 2
Glucagon-Like Peptide 1
Glucose
Hyperglycemia
Insulin
Insulin Resistance
Mortality
Sodium
Glucagon-Like Peptide 1
Glucose
Insulin
Sodium

Figure

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  Figure 1 Antihyperglycemic therapy algorithm for adult patients with type 2 diabetes mellitus. DPP4i, dipeptidyl peptidase 4 inhibitor; SGLT2i, sodium-glucose cotransporter 2 inhibitor; TZD, thiazolidinedione; GLP-1RA, glucagon-like peptide 1 receptor agonist; SU, sulfonylurea; AGI, α-glucosidase inhibitor; GLN, glinide (meglitinide). Reproduced from Ko SH, et al. Diabetes Metab J 2017;41:337-348, according to the Creative Commons license [5].

Reference

1. Kim DJ. The epidemiology of diabetes in Korea. Diabetes Metab J. 2011; 35:303–308.

2. Defronzo RA. Banting Lecture. From the triumvirate to the ominous octet: a new paradigm for the treatment of type 2 diabetes mellitus. Diabetes. 2009; 58:773–795.

3. Tancredi M, Rosengren A, Svensson AM, Kosiborod M, Pivodic A, Gudbjornsdottir S, Wedel H, Clements M, Dah-lqvist S, Lind M. Excess mortality among persons with type 2 diabetes. N Engl J Med. 2015; 373:1720–1732.

4. Owens DR, Monnier L, Hanefeld M. A review of glucagon-like peptide-1 receptor agonists and their effects on lowering postprandial plasma glucose and cardiovascular outcomes in the treatment of type 2 diabetes mellitus. Diabetes Obes Metab. 2017; 19:1645–1654.

5. Ko SH, Hur KY, Rhee SY, Kim NH, Moon MK, Park SO, Lee BW, Kim HJ, Choi KM, Kim JH; Committee of Clinical Practice Guideline of Korean Diabetes Association. Antihyperglycemic agent therapy for adult patients with type 2 diabetes mellitus 2017: a position statement of the Korean Diabetes Association. Diabetes Metab J. 2017; 41:337–348.

6. Moon MK, Hur KY, Ko SH, Park SO, Lee BW, Kim JH, Rhee SY, Kim HJ, Choi KM, Kim NH; Committee of Clinical Practice Guidelines of the Korean Diabetes Association. Com-bination therapy of oral hypoglycemic agents in patients with type 2 diabetes mellitus. Korean J Intern Med. 2017; 32:974–983.

7. Lee BW, Kim JH, Ko SH, Hur KY, Kim NH, Rhee SY, Kim HJ, Moon MK, Park SO, Choi KM; Committee of Clinical Practice Guideline of Korean Diabetes Association. Insulin therapy for adult patients with type 2 diabetes mellitus: a position statement of the Korean Diabetes Association, 2017. Diabetes Metab J. 2017; 41:367–373.

8. Nair S, Wilding JP. Sodium glucose cotransporter 2 inhibitors as a new treatment for diabetes mellitus. J Clin Endocrinol Metab. 2010; 95:34–42.

9. Vasilakou D, Karagiannis T, Athanasiadou E, Mainou M, Liakos A, Bekiari E, Sarigianni M, Matthews DR, Tsapas A. Sodium-glucose cotransporter 2 inhibitors for type 2 diabetes: a systematic review and meta-analysis. Ann Intern Med. 2013; 159:262–274.

10. Zinman B, Wanner C, Lachin JM, Fitchett D, Bluhmki E, Hantel S, Mattheus M, Devins T, Johansen OE, Woerle HJ, Broedl UC, Inzucchi SE;. Empagliflozin, cardiovascular outcomes, and mortality in type 2 diabetes. N Engl J Med. 2015; 373:2117–2128.

11. Neal B, Perkovic V, Mahaffey KW, de Zeeuw D, Fulcher G, Erondu N, Shaw W, Law G, Desai M, Matthews DR; CANVAS Program Collaborative Group. Canagliflozin and cardiovascular and renal events in type 2 diabetes. N Engl J Med. 2017; 377:644–657.

12. Tahara A, Kurosaki E, Yokono M, Yamajuku D, Kihara R, Hayashizaki Y, Takasu T, Imamura M, Qun L, Tomiyama H, Kobayashi Y, Noda A, Sasamata M, Shibasaki M. Pharma-cological profile of ipragliflozin (ASP1941), a novel selective SGLT2 inhibitor, in vitro and in vivo. Naunyn Schmiedebergs Arch Pharmacol. 2012; 385:423–436.

13. Heise T, Hovelmann U, Brondsted L, Adrian CL, Nosek L, Haahr H. Faster-acting insulin aspart: earlier onset of appearance and greater early pharmacokinetic and pharma-codynamic effects than insulin aspart. Diabetes Obes Metab. 2015; 17:682–688.

14. Tosaki T, Kamiya H, Yamamoto Y, Himeno T, Kato Y, Kondo M, Yamada Y, Inagaki A, Tsubonaka K, Oshiro C, Katayama T, Hayasaki T, Nakaya Y, Fujiyoshi H, Nakamura J. Efficacy and patient satisfaction of the weekly dpp-4 inhibitors trelagliptin and omarigliptin in 80 Japanese patients with type 2 diabetes. Intern Med. 2017; 56:2563–2569.

15. Herrero P, Bondia J, Oliver N, Georgiou P. A coordinated control strategy for insulin and glucagon delivery in type 1 diabetes. Comput Methods Biomech Biomed Engin. 2017; 20:1474–1482.