Diabetes Update: New Pharmacotherapy for Type 2 Diabetes

Multiple new drugs for managing type 2 diabetes have entered the market in the past 5 years. Guidelines from the American Diabetes Association recommend metformin for initial therapy, followed by a second drug if A1c goals are not met or initially for patients with A1c levels greater than 9%. Conversely, the American Association of Clinical Endocrinologists recommends initial management with two drugs if the A1c level is greater than 7.5%. The risk of lactic acidosis associated with metformin has been shown to be less than previously thought, with newer guidelines permitting use with an estimated glomerular filtration rate of 45 to 60 mL/min/1.73 m². Newer studies provide a better understanding of the mechanisms of and indications for use of sodium-dependent glucose cotransporter 2 inhibitors, glucagon-like peptide 1 receptor agonists, and inhaled insulin.