Perspectives

Niche oral agents in type 2 diabetes

Perspectives

Niche oral agents in type 2 diabetes

Ryan Jalleh, Stephen Stranks

Figures

© TOWFIQU AHAMED/ ISTOCKOPHOTO.COM
© TOWFIQU AHAMED/ ISTOCKOPHOTO.COM

Abstract

Alpha-glucosidase inhibitors (e.g. acarbose) and thiazolidinediones (e.g. pioglitazone) are older classes of oral type 2 diabetes medication that are less commonly used because of their undesirable side effects. However, they are still effective therapeutic agents and may be considered when formulating a personalised management plan for patients with type 2 diabetes.

Key Points

  • Alpha-glucosidase inhibitors (e.g. acarbose) and thiazolidinediones (e.g. pioglitazone) have not been definitively shown in prospective trials to have specific effects in reducing cardiovascular events or mortality in people with type 2 diabetes but may have niche roles in their treatment.
  • Although many patients do not tolerate acarbose because of gastrointestinal side effects, its use may delay progression of impaired glucose tolerance to type 2 diabetes.
  • Risk of hypoglycaemia on acarbose or thiazolidinedione monotherapy is low; however, if used in combination with insulin, sulfonylurea therapy (or fibrates in the case of thiazolidinediones), hypoglycaemia risk is increased.
  • Thiazolidinediones are an effective oral agent in treatment of patients with type 2 diabetes but have been associated with significant adverse effects and must be used judiciously.