Type 2 diabetes mellitus: new therapeutic perspectives

UKPDS: The results of the United Kingdom Prospective Diabetes Study (UKPDS) were reported in 1998. This multi-center, prospective, randomized, intervention trial of 5102 newly-diagnosed patients with type 2 diabetes mellitus was aimed at determining whether improved blood glucose control can prevent complications and reduce associated morbidity and mortality. The results: Improved blood glucose control was shown to reduce the number of complications, mainly by reducing the effect of microangiopathy. There was however no reduction in the number of diabetes-related deaths nor in the risk of myocardial dial infarction or sudden death. Controversy over calcium antagonists: Calcium antagonists are suspected of increasing the risk of cardiovascular disease. On the basis of published reports, the JNC VI guidelines are recommended: calcium antagonists should not be used as first line treatment in diabetics. Recent drugs: Acarbose, an alpha-glucosidase inhibitor, lowers post-prandial blood glucose level. It has marketing approval for single-drug regimens in France Miglitol, another alpha-glucosidase inhibitor, would have the same therapeutic effect Orliatort, an gastro-intestinal lipase inhibitor, is indicated in obese patients but long-term results are lacking to evaluate effects in diabetics.