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ABSTRACT: The development of new drugs for the treatment of type 2 diabetes (T2DM) and metabolic disorders is currently one of the most innovative areas of drug development. However, a considerable number of newly developed drugs have either not reached the market and were stopped late in development or have been withdrawn after initial approval soon after market authorization due to serious safety concerns. How can drug safety problems be anticipated and, even more important, how can adverse events definitely caused by a drug be differentiated from incidences of naturally occurring diseases? This review article will provide an update about the state of the art treatment of type 2 diabetes and reflect on the newest available study evidence on glitazones, incretin mimetics (GLP-1 agonists and DPP-4 inhibitors), SGLT-2 inhibitors (gliflocines) and pan-PPAR agonists (glitazars). Furthermore, new and still experimental approaches for the treatment of T2DM, such as bardoxolone, salsalate and anakinra will be briefly reviewed.
Der Internist 03/2012; 53(4):478, 480-5, 487. · 0.30 Impact Factor
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ABSTRACT: Currently, the oral glucose tolerance test remains the "gold standard" for diagnosing type 2 diabetes, HbA (1c) being of subordinate value because of its limited diagnostic sensitivity. Fully evaluated risk scores and questionnaires are helpful in determining individual type 2 diabetes risk profiles and may prove valuable tools in preventing this type of diabetes. Genetic studies support our current understanding of the pathophysiology of type 2 diabetes. In the near future genetic data may become useful in optimizing individual preventative and therapeutic strategies. Recent data suggest that it is reasonable to adjust therapeutic aims on the specific situation of individual patients for achieving optimal results. The present therapeutic armamentarium for the treatment of type 2 diabetes has been rapidly extended over the recent years. To deal with this situation, pharmacovigilance is an essential tool to ensure drug safety and improve existing therapeutic standards.
DMW - Deutsche Medizinische Wochenschrift 04/2011; 136(14):675-8. · 0.53 Impact Factor
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ABSTRACT: To characterize bio-psycho-social factors, particularly mental disorders and self-harm behaviour, associated with the development of diabetic foot ulcers.
Two groups of diabetic patients with and without foot ulcers (n=47 in each group) with similar sex, age and diabetes duration were assessed for mental disorders using the Composite International Diagnostic Interview. Self-harm behaviour, quality of life, depressive symptoms and self-compassion were rated using different standard questionnaires.
Patients from the ulcer group visited their practitioners and/or psychotherapists less frequently in the last 12 months than patients in the control group 0 vs. 13%; P=0.026). The ulcer group patients had a history of increased alcohol consumption (43 vs. 19%; P=0.025), lower levels of education (8 vs. 10 grades; P=0.014) and income (1190 vs. 1535 €/month; P=0.039). Additionally, they were less likely to be diagnosed with anxiety disorders (11 vs. 32%; P=0.022). No significant differences in glycated haemoglobin, body mass index, smoking and direct self-harm behaviour were identified.
Patients with foot ulcers tend to exhibit lower health-conscious behaviour, particularly higher lifetime alcohol consumption, lower utilization of medical services and less general anxiety. Practitioners should be aware of these behaviours, since early detection of diabetes patients at psycho-social risk and consecutive psychological intervention may be an effective preventive strategy in avoiding the development of foot ulcers.
Diabetic Medicine 02/2011; 28(2):168-74. · 2.90 Impact Factor
