Hot Topics in Diabetes
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ISSN (printed): 2282-345X. ISSN (electronic): 2282-4383.
Despite the fact that diabetes mellitus was described by Aretaeus of Cappadocia about 2,000 years ago, the first treatment, insulin, has been available less than 100 years, the first sulfonylurea has been available since 1946, and biguanides have been available since 1957. Since insulin’s discovery in 1921, a lot of progress has been made, starting with animal insulin and leading to different insulin analogs. The same progress related to insulin administration has occurred, from the classic insulin syringe and insulin vials to present-day insulin devices (pens) with or without memory storage and replaceable or prefilled cartridges to the continuous subcutaneous insulin infusion pumps that substantially ease insulin administration and offer accurate dosing. But still, insulin is administered subcutaneously, by injection, and not physiologically, in the portal vein. Much research in this field continues in quest of a needle-free administration, which can reduce the barriers to insulin treatment, increase adherence to treatment, and improve glycemic control. Many new compounds and devices are in the pipeline, such as oral insulin and oral insulin-mimetic compounds, buccal insulin spray, nasal gel, and transdermal patches. All these must demonstrate their safety and efficacy before approval for general patient use. Also, in terms of antidiabetic drugs, since the first generation of sulfonylureas was introduced in type 2 diabetes treatment, second- and third-generation sulfonylureas have been developed, which are safer than the earlier ones. The sulfonylureas stimulate insulin secretion from the pancreatic β-cells. Metformin, an insulin sensitizer also introduced in the United States in 1995, is the only biguanide available in many countries once phenformin and buformin were withdrawn after being associated with lactic acidosis. Currently, metformin represents the cornerstone of type 2 diabetes treatment together with lifestyle interventions in many international guidelines. After these 2 classic therapeutic classes of antidiabetic drugs came an amazing cascade of other ones, concentrated in less than 20 years, with many new compounds in development. This progress in diabetes treatment has occurred in parallel with an understanding of its complex and multifactorial etiopathogenesis, which at present is incompletely known and, consequently, is not addressed. The definition and classification of diabetes has changed with time according to the knowledge accumulated at that particular moment. Diabetes is defined now as “a group of metabolic diseases characterized by hyperglycemia resulting from defects in insulin secretion, insulin action, or both,” comprising type 1 and type 2 diabetes, other specific types, and gestational diabetes. Chronic hyperglycemia leads to specific late complications. The alarming increasing in prevalence of type 2 diabetes, the progressive nature of the disease, and the accompanying disabling complications create an urgent need for new drugs and strategies for treatment, as well as continued research to answer the still unanswered questions in diabetes prevention, diagnosis, treatment, and control.
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