[The present and future of treatment with oral antidiabetic agents]

Oral antidiabetics (PAD) are still the most frequent pharmacotherapeutic intervention in NIDDM, characterized by insulin deficiency and in particular by insulin resistance in the liver and peripheral tissues. Depending on the site of action, they are divided into substances retarding carbohydrate breakdown in the small intestine (alpha-glucosidase inhibitors), substances stimulating B-cells of the islets of Langerhans (beta-cytotropic substances) and substances acting in the periphery. The authors discuss PAD, in particular SU and biguanides which have been used for treatment for some years and more recent preparations--acarbose (Glucobay) and miglitol. Attention is paid to perspective preparation which are in the research stage, among them in particular troglitazone which belongs into the group of substances which improve the sensitivity of insulin receptors (insulin sensitizers) which will soon be on the market. As to other possibilities the authors discuss the role of fatty acid oxidation and its inhibitors and new non-sulphonyl urea insulin secretagogues. All these preparations, despite certain limitations, offer exciting therapeutic perspectives. Further research will reveal to what extent this potential can be implemented in practice.