Therapeutic options for the management of type 2 diabetes mellitus

The incidence of diabetes mellitus is steadily increasing in the United States. Currently the United States spends approximately $100 billion in healthcare costs annually for the management of diabetes. Most of the costs are attributed to hospitalizations and treatment of diabetes complications. Preventing these complications with tight glycemic control is the key to reducing morbidity, mortality, and healthcare costs secondary to diabetes mellitus. Recently, the American College of Endocrinology also stressed earlier screening for diabetes and endorsed lowering the goal percent of hemoglobin glycosylation to 6.5%. These strategies help identify patients with diabetes at an earlier stage and in turn prevent more complications. Better control of diabetes is now feasible with the recent approval of 8 new antidiabetic products. Pioglitazone and rosiglitazone are agents with a novel mechanism of action. Metformin XR, insulin aspart, and miglitol are agents that are similar to previously marketed products, but have different pharmacokinetic or pharmacodynamic properties. Metformin/glyburide is the first combination product for the treatment of diabetes. Nateglinide represents the first agent in a new class of antidiabetic agents and insulin glargine is a novel insulin preparation. All of the agents have unique characteristics that may render them useful in specific patient populations.