New Orally Administered Antihyperglycemic Agents for the Management of Patients with Type II Diabetes and the Syndrome of Insulin Resistance

Abstract

To describe several newly developed orally administered antidiabetic drugs, which are effective for type II diabetes. Detailed clinical information about three types of antihyperglycemic agents--carbohydrase inhibitors, biguanides, and thiazolidinediones--is presented. Miglitol and acarbose, two a-glucosidase inhibitors, effectively reduce postprandial blood glucose values and do not cause hypoglycemia. The biguanide metformin has been shown to suppress hepatic glucose production, augment glucose uptake, and enhance insulin action in peripheral tissues. Metformin is effective alone or in combination with other orally administered antidiabetic agents or insulin. A new class of antidiabetic agents called the thiazolidinediones (not yet available for clinical use) apparently works by mainly reducing insulin resistance in skeletal muscle. The most extensively studied drug in this category is troglitazone. Carbohydrase inhibitors as well as biguanides may be useful in patients with the insulin resistance syndrome, especially those with obesity, hypertension, and hyperinsulinemia. Because of the development of new antihyperglycemic agents for oral administration, the need for insulin injections in patients with type II diabetes will be minimized, and the clinical management of such patients will be improved.