Type 2 diabetes. How new insights, new drugs are changing clinical practice

In 1997, the American Diabetes Association recommended a normal fasting blood glucose of < 126 mg/dL as the criteria for diagnosis of type 2 diabetes. Since then, new data have suggested that post-prandial glucose may have a stronger correlation with cardiovascular disease than fasting blood glucose. Two trials, the DCCT and UKPDS, provided evidence of the relationship between hyperglycemia and long-term diabetic complications. Preventing short-term complications, such as cognitive decline, is a more immediate goal and less well-studied. Type 2 diabetes is understood to result most often from insulin resistance and insulin deficiency. New classes of drugs offer expanded therapeutic options for managing this dual metabolic defect. These drugs have invalidated the former therapeutic paradigm of diet, sulfonylureas, and then insulin therapy.