Advances in Diabetes Treatment

The discovery of insulin in 1921 by Fredrick Banting and Charles Best was one of the major medical achievements in the 20th century. Insulin remains the fundamental treatment for Type 1 diabetes. Type 2 diabetics may need insulin, but recent clinical research has created a number of effective medicines to help control blood sugar levels and reduce risk for cardiovascular and other diseases caused by diabetes.

Today, diabetes care focuses on finding the best combination of therapies to reduce and maintain a person's glucose level-long-term and without weight gain-to protect against cardiovascular diseases. Metformin remains the cornerstone of Type 2 therapy and is used in combination with newer drugs to provide better control. Newer drugs include TZDs (thiazolidinediones) and two new classes of drugs, DPP-4 inhibitors, and GLP-1 analogs.

Both DDP-4 inhibitors and GLP-1 analogs act though a hormone called GLP-1 which helps to stimulate insulin secretion. DPP-4 inhibitors prevent an enzyme from inactivating GLP-1. GLP-1 analogs are synthetic versions of GLP-1, which increases insulin. The DPP-4 inhibitors Januvia (sitagliptin) and Onglyza (saxagliptin) were introduced in 2008 and 2009. The GLP-1 analog Victoza (liraglutide) was introduced in 2010.   

Among the most recent introductions are Tradjenta, approved in 2011 for glycemic control in diabetes, and Bydureon, approved in 2012 as a once-weekly treatment for Type 2 diabetes.

In obesity therapy, two new drugs, Belviq and Qsymia, were approved in 2012. Agents  currently in clinical trials include aloglyptin, lixisenatide, and albiglutide. 

The rich diabetes research pipeline holds more than 500 potential medicines. Today's diabetes clinical trials are among the longest and most complex studies ever conducted. Advancing knowledge has increased awareness of the inter-relatedness of diabetes, weight gain and risk for heart disease. Today's antidiabetes medicines must address all these effects and risks to be effective and safe for long-term use. 

Cowen and Company, 2012. Therapeutic Categories Outlook.

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