Management of Type 2 Diabetes: Selecting Amongst Available Pharmacological Agents

Emily B. Schroeder

Management of Type 2 Diabetes: Selecting Amongst Available Pharmacological Agents

Review

In: Endotext [Internet]. South Dartmouth (MA): MDText.com, Inc.; 2000.

2026 Apr 12.

Author

Emily B. Schroeder¹

Book Editors

Kenneth R Feingold¹, Robert A. Adler², S. Faisal Ahmed³, Bradley Anawalt⁴, Marc R Blackman⁵, George Chrousos⁶, Emiliano Corpas⁷, Wouter W de Herder⁸, Ketan Dhatariya⁹, Kathleen Dungan¹⁰, Emma Hamilton¹¹, Johannes Hofland¹², Suzanne Jan de Beur¹³, Sanjay Kalra¹⁴, Gregory Kaltsas¹⁵, Nitin Kapoor¹⁶, Matthew Kim¹⁷, Christian Koch¹⁸, Peter Kopp¹⁹, Márta Korbonits²⁰, Christopher S Kovacs²¹, Wendy Kuohung²², Blandine Laferrère²³, Miles Levy²⁴, Elizabeth A McGee²⁵, Robert McLachlan²⁶, Radhika Muzumdar²⁷, Jonathan Purnell²⁸, Rodolfo Rey²⁹, Rakesh Sahay³⁰, Amy S Shah³¹, Mark A Sperling³², Constantine A Stratakis³³, Dace L Trence³⁴, Don P Wilson³⁵

Affiliation

¹ Parkview Health, Fort Wayne, IN

Book Affiliations

¹ Professor of Medicine Emeritus, University of California, San Francisco, CA
² Chief of Endocrinology and Metabolism at the Richmond Veterans Affairs Medical Center and Professor of Internal Medicine at Virginia Commonwealth University.
³ Developmental Endocrinology Research Group, University of Glasgow, Glasgow, UK
⁴ Chief of Medicine at the University of Washington Medical Center and Professor and Vice Chair of the Department of Medicine, University of Washington
⁵ Sr. Physician Scientist, Washington DC VA Medical Center; Professor of Medicine & Rehabilitation Medicine, Georgetown University; Clinical Professor of Medicine, Biochemistry and Molecular Medicine, George Washington University; and Professor of Medicine (Part-time), Johns Hopkins University
⁶ Professor of Pediatrics and Endocrinology, Division of Endocrinology, Metabolism and Diabetes, First Department of Pediatrics, National and Kapodistrian University of Athens Medical School, "Aghia Sophia" Children's Hospital, Athens, Greece
⁷ M.D. Ph.D in Gerontology. Honorary Professor of Medicine, Universidad de Alcalá, Madrid. Consultant in Endocrinology, Hospital HLA Guadalajara (Spain).
⁸ Professor of Endocrine Oncology, Erasmus MC and Erasmus MC Cancer Center, Rotterdam, the Netherlands
⁹ Consultant in Diabetes, Endocrinology and General Medicine, Norfolk and Norwich University Hospitals NHS Foundation Trust and University of East Anglia, Norwich, UK.
¹⁰ Professor of Medicine, Division of Endocrinology, Diabetes, and Metabolism, Ohio State University
¹¹ Consultant Endocrinologist at Fiona Stanley (FSH) and Fremantle Hospitals (FH) in Perth, Western Australia
¹² Consultant Endocrinologist, Erasmus MC and Erasmus MC Cancer Center, Rotterdam, the Netherlands
¹³ Professor of Endocrinology and Chief of the Division of Endocrinology and Metabolism at the University of Virginia School of Medicine.
¹⁴ Consultant Endocrinologist, Department of Endocrinology, Bharti Hospital, Karnal, India
¹⁵ Professor of General Medicine-Endocrinology, 1st Department of Propaedeutic Medicine, National and Kapodistrian University of Athens, Athens, Greece
¹⁶ Professor of Endocrinology, Department of Endocrinology, Diabetes and Metabolism, Christian Medical College & Hospital, Vellore, Tamil Nadu, India, Melbourne School of Population and Global Health, Faculty of Medicine, Dentistry and Health Science, The University of Melbourne, Australia.
¹⁷ Clinical Director of the Division of Endocrinology, Diabetes and Hypertension at Brigham and Women’s Hospital and an Assistant Professor of Medicine at Harvard Medical School. 18. Professor, Division of Endocrinology, Diabetes, Metabolism, Department of Medicine, The University of Tennessee Health Science Center, Memphis, TN, and University of Florida, Jacksonville, FL.
¹⁸ Professor, The University of Tennessee Health Science Center, Memphis, Tennessee
¹⁹ Professor of Medicine and Chief of the Division of Endocrinology, Diabetology and Metabolism, University of Lausanne, Switzerland
²⁰ Professor of Endocrinology and Metabolism, Centre Lead for Endocrinology and Deputy Institute Director, William Harvey Research Institute, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, England
²¹ University Research Professor and Professor of Medicine (Endocrinology and Metabolism), Obstetrics & Gynecology, and BioMedical Sciences, at Memorial University of Newfoundland in St. John’s, Newfoundland, Canada.
²² Director of the Division of Reproductive Endocrinology at Boston Medical Center and an Associate Professor of Obstetrics and Gynecology at the Boston University School of Medicine
²³ Professor of Medicine, New York Nutrition Obesity Research Center, Division of Endocrinology, Department of Medicine, Columbia University Irving Medical Center, New York, NY, USA.
²⁴ Consultant endocrinologist at University Hospitals of Leicester and Honorary Associate Professor at Leicester University
²⁵ Professor of Obstetrics and Gynecology at the University of Vermont and Director of the Division of Reproductive Endocrinology and Infertility. Burlington, Vermont
²⁶ Director of Clinical Research, Hudson Institute of Medical Research; Consultant Endocrinologist, Monash Medical Centre, Melbourne, Australia
²⁷ Allan L. Drash Endowed Chair, Chief, Division of Endocrinology and Diabetes, UPMC Children’s Hospital of Pittsburgh, Professor of Pediatrics and Cell Biology, University of Pittsburgh School of Medicine, Pittsburgh, PA
²⁸ Professor of Medicine, Knight Cardiovascular Institute and the Division of Endocrinology, and Associate Director, Bob and Charlee Moore Institute for Nutrition and Wellness, Oregon Health and Science University, Portland, OR
²⁹ Centro de Investigaciones Endocrinológicas “Dr. César Bergadá” (CEDIE), CONICET-FEI-División de Endocrinología, Hospital de Niños Ricardo Gutiérrez, Gallo 1330, C1425EFD Buenos Aires; and Departamento de Histología, Biología Celular, Embriología y Genética, Facultad de Medicina, Universidad de Buenos Aires, C1121ABG Buenos Aires, Argentina
³⁰ Professor and Head of Department of Endocrinology, Osmania Medical College and Osmania General Hospital, Hyderabad, India.
³¹ Professor of Pediatrics, The University of Cincinnati, Department of Pediatrics and Cincinnati Children’s Hospital Medical Center, Division of Endocrinology, Cincinnati, OH, USA
³² Professorial Lecturer, Division of Pediatric Endocrinology and Diabetes, Icahn School of Medicine at Mount Sinai, New York, NY. Emeritus Professor and Chair, Department of Pediatrics, University of Pittsburgh.
³³ CSO, ELPEN, Inc. & Director, Research Institute, Athens, Greece & Senior Investigator, Human Genetics & Precision Medicine, FORTH (ITE), Heraklion, Greece. Emeritus Scientific Director & Senior Investigator, NICHD, NIH, Bethesda, MD, USA
³⁴ Professor of Medicine, Emeritus, University of Washington, Seattle, WA
³⁵ Endowed Chair, Cardiovascular Health and Risk Prevention, Pediatric Endocrinology and Diabetes, Cook Children's Medical Center, Fort Worth, TX

PMID: 28402618
Bookshelf ID: NBK425702

Excerpt

In the early 1990’s, clinicians’ choices for pharmacological management of type 2 diabetes were limited to insulin, sulfonylureas, and metformin. Since then, many classes of agents have been discovered, approved, and put into clinical use. Through a series of cardiovascular outcome trials and other clinical trials, some classes of agents have been found to have benefits on atherosclerotic cardiovascular disease, congestive heart failure, chronic kidney disease, and metabolic comorbidities, sometimes independent of glycemic control. As a result, diabetes management has shifted away from a “one size fits all” care to an individualized approach for each patient. Important factors to consider include efficacy, cost, side effects, adherence and treatment burden, comorbidities, mechanisms of action, and non-glycemic effects on atherosclerotic cardiovascular disease, congestive heart failure, chronic kidney disease, obesity, and metabolic liver disease. The goal of this chapter is to discuss an approach to pharmacological management that reviews current guidelines, discusses choosing appropriate glycemic targets, and presents the rationale for choosing certain medications in different situations. For complete coverage of all related areas of Endocrinology, please visit our on-line FREE web-text, WWW.ENDOTEXT.ORG.

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