Review
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World J Diabetes. Oct 15, 2014; 5(5): 636-650
Published online Oct 15, 2014. doi: 10.4239/wjd.v5.i5.636
Treatment of type 2 diabetes, lifestyle, GLP1 agonists and DPP4 inhibitors
Gerald H Tomkin
Gerald H Tomkin, Diabetes Institute of Ireland, Beacon Hospital, Sandyford, Dublin 18, Ireland
Gerald H Tomkin, Department of Diabetes and Endocrinology, Trinity College, Dublin 2, Ireland
Author contributions: Tomkin GH solely contributed to this paper.
Correspondence to: Gerald H Tomkin, Professor, Diabetes Institute of Ireland, Beacon Hospital, Sandyford, Clontra, Quinns Road, Shankill, Dublin 18, Ireland. gerald.tomkin@tcd.ie
Telephone: +353-1-2390658 Fax: +353-1-2721395
Received: January 26, 2014
Revised: July 23, 2014
Accepted: July 27, 2014
Published online: October 15, 2014
Abstract

In recent years the treatment focus for type 2 diabetes has shifted to prevention by lifestyle change and to more aggressive reduction of blood sugars during the early stage of treatment. Weight reduction is an important goal for many people with type 2 diabetes. Bariatric surgery is no longer considered a last resort treatment. Glucagon-like peptide-1 agonists given by injection are emerging as a useful treatment since they not only lower blood sugar but are associated with a modest weight reduction. The role of the oral dipeptidyl peptidase 4 inhibitors is emerging as second line treatment ahead of sulphonylureas due to a possible beneficial effect on the beta cell and weight neutrality. Drugs which inhibit glucose re-absorption in the kidney, sodium/glucose co-transport 2 inhibitors, may have a role in the treatment of diabetes. Insulin treatment still remains the cornerstone of treatment in many patients with type 2 diabetes.

Keywords: Type 2 diabetes, Lifestyle modification, Dipeptidyl peptidase 4 inhibitors, Glucagon-like peptide-1 agonists, Insulin

Core tip: Treatment of diabetes is difficult. Initial success in achieving treatment goals is followed by deterioration and the necessity for additional treatments. Exciting new drugs with new modes of action, have stimulated diabetologists to strive for improved control in the knowledge that complications will be reduced or prevented. Obese patients, who loose weight on glucagon-like peptide-1 agonists are usually delighted with these drugs but for those who fail to loose weight changing to oral dipeptidyl peptidase-4 inhibitors would seem a good choice. sodium-glucose transporter-2 inhibitors have the added benefit of being effective even if blood sugar is near to target but uro-genital infection is a concern.