Treatment of type 2 diabetes: future approaches

Introduction or background: Type 2 diabetes, which accounts for ~90% of all diabetes, is a heterogeneous and progressive disease with a variety of causative and potentiating factors. The hyperglycaemia of type 2 diabetes is often inadequately controlled, hence the need for a wider selection of glucose-lowering treatments. Sources of data: Medline, PubMed, Web of Science and Google Scholar. Areas of agreement: Early, effective and sustained control of blood glucose defers the onset and reduces the severity of microvascular and neuropathic complications of type 2 diabetes and helps to reduce the risk of cardiovascular (CV) complications. Areas of controversy: Newer glucose-lowering agents require extensive long-term studies to confirm CV safety. The positioning of newer agents within therapeutic algorithms varies. Growing points: In addition to their glucose-lowering efficacy, some new glucose-lowering agents may act independently to reduce CV and renal complications. Areas timely for developing research: Studies of potential new glucose-lowering agents offer the opportunity to safely improve glycaemic control with prolonged efficacy and greater opportunity for therapeutic individualisation.