Although type 2 diabetes has tripled since 1960, current treatments remain antiquated, according to an August 1995 article in Clinical and Investigative Medicine.
According to Robert Tattersall, MD, author of the article, less than a quarter of people with type 2 diabetes have normal blood sugar, and no new therapies seem to offer any promise of changing that figure.
Tattersall points out that what we would now call a low carbohydrate diet was first used in 1796. Insulin was first introduced in 1922. Tolbutamide and chlorpropamide were marketed, along with amphetamine as an anorectic agent, in the 1950’s.
The August 1995 introduction of Amaryl, acarbose and metformin may appear to offer a smorgasbord of new treatments, but these drugs don’t represent a revolution in diabetes therapy. The recent introduction of Amaryl only adds another brand-name to the long list of sulphonylureas, and, according to Tattersall, metformin has been available in Europe for over 30 years but only became available in the United States in 1995.
“In fact, metformin is a remarkably effective drug when tested head-to-head against sulphonylureas,” Tattersall says. The advantage of metformin is that it controls blood sugar as well as sulphonylureas, but without the weight gain.
“Acarbose is the only truly new drug introduced during the past two decades,” Tattersall says. But he also points out that acarbose’s “place in therapy is not entirely clear.”
According to Tattersall, use of these drugs varies from country to country, signaling a lack of medical conviction for a precise way to use them. The only way Tattersall sees the majority of people with type 2 diabetes achieving normal blood sugar is through multiple therapies.
“I can easily foresee a situation where a patient with (type 2 diabetes) is on three antihyperglycemic agents and, since so many people also have hypertension and hyperlipidaemia, a blood pressure lowering drug (or two) and a lipid lowering agent,” Tattersall says.
“It raises very big potential issues of compliance,” Tattersall adds. “How many of us would be prepared to take five different drugs to treat an asymptomatic disorder?”
In response to the use of acarbose, Steve Edelman, MD, from the Veterans Hospital in San Diego points out that acarbose can control the common problem of post-meal elevations in blood sugar.