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Diabetes treatment newer trends

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Source: BMJ 2009;338:b1668

New NICE guidelines in the UK on newer drugs for use in diabetes are summarised in the BMJ. Some key points are:
  1. Add sitagliptin (a DPP-4 inhibitor) as second line treatment with metformin instead of a sulphonylurea when blood glucose control is inadequate if sulphonylureas are contraindicated or if the patient is at risk of hypoglycaemia
  2. Add sitagliptin or a thiazolidinedione (pioglitazone or rosiglitazone) as a third line treatment if metformin and a sulphonylurea are not adequately controlling blood glucose and insulin is unsuitable
  3. Don't use thiazolidinediones in patients with heart failure or at high risk of fracture
  4. Add pioglitazone to insulin therapy if a thiazolidinedione has lowered blood glucose in the past or if high dose insulin is not adequately controlling blood glucose.
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