[Drug treatment of type 2 diabetes]

Diabetes mellitus and its complications constitute a major health problem in modern societies. The disease affects approximately 5% of the adult population in western countries. The underlying process of the metabolic disorder is a defect in insulin secretion, insulin action, or both. Weight reduction, calorie restriction and patient education remain the cornerstones of the management of type 2 diabetes. When lifestyle modification fails to maintain adequate glycaemic control, insulin or oral hypoglycemic agents are typically used to manage the disease. The currently available five classes of oral agents differ in mechanism and duration of action, the degree to which they lower blood glucose and their side-effect profile. For most of these antiglycaemic agents, there is a lack of evidence on the effects on long-term complications. Only metformin has clearly proved that it can reduce mortality in obese patients with type 2 diabetes. Human insulin reduces acute and long-term mortality in patients with CVD. Furthermore, intensive treatment either with insulin or sulfonylurea has proved that it can prevent microvascular complications in type 2 diabetes. Additional randomized controlled trails assessing hard clinical endpoints are needed to better inform patients and enable physicians to establish optimal treatment strategies.