[New avenues for pharmacotherapy of type 2 diabetes mellitus]

Pharmaceutical products reviewed in this paper markedly extend possibilities for the management of DM-2 and create prerequisites for diferential therapy of this disease. Exenatide and DPP-4 inhibitors do not cause hypoglycemia and may be prescribed to subjects in whom this condition may affect the ability to drive or operate machinery (drivers, pilots, etc.). The mechanism of action of DPP-4 inhibitors make them especially suitable for the treatment of early stages of DM-2 when B-cells are still capable of insulin secretion. They can be used at a dose of 100 mg once daily both for monotherapy and in combination with other oral hypoglycemic agents. These drugs are well tolerated by the patients but contraindicated to those with severe renal insuficiency. Exenatid is more eficacious than DPP-4 inhibitors and has advantages over insulin therapy because it does not increase body weight and do not require as frequent blood glucose monitoring. However, it produces side effects. Therefore, the treatment should be started with a low dose of the drug (5 mg subcutaneously twice daily) that can be doubled in 4 weeks. Bearing in mind the mechanism of action of exanatide, it is indicated largely to patients with DM-2 associated with obesity and a moderately elevated HbAlc level. Rimonabant is especially efficient due to its effect on the endocannabioid system of DM-2 patients with obesity, however it has a drawback of frequently producing adverse affects.