From ADA Clinical Diabetes:
Although the number of diabetes treatments has substantially increased in the past two decades, today's therapies are considered far from ideal. Yet, what constitutes an ideal therapy is not readily clear, as diabetes drug therapies are regularly judged both by their effects on glycemia and by a wide variety of nonglycemic metrics. This review describes the characteristics of an ideal diabetes therapy from the perspective of patients, physicians, payors, and financial analysts and examines how well currently available therapies and several late-stage candidates meet these guideposts.
The number of approved diabetes drug therapies (referred to hereafter simply as “therapies”) has grown significantly in the past two decades. In 1994, lifestyle-directed interventions, metformin, sulfonylureas, and insulin were the only glucose-lowering therapies in widespread use. Today, 11 classes of diabetes drugs are available, and many more are in development.
Despite this increase, diabetes was the leading cause of blindness, kidney failure, and nontraumatic lower-limb amputations in the United States in 2011,1 and treating diabetes complications cost the United States $22.9 billion in 2006.2 These figures can be at least partially attributed to the use of highly imperfect diabetes therapy options that have limited efficacy, inconvenient side effects, and unfavorable delivery methods.
Yet, how we define an “ideal” diabetes treatment is not clear cut because new diabetes medications are evaluated for qualities ranging from their effects on glucose homeostasis to their effects on cardiovascular mortality. More closely defining the characteristics of an optimal therapy is of interest for evaluating the performance of current drugs and understanding how much extra benefit therapies in development will provide.
In this review, we explore what an ideal diabetes therapy would look like from the perspective of several key stakeholders in diabetes drug development. We then discuss the most commonly used current diabetes therapies and a number of therapies in development and assess how well each of these meets the criteria for an ideal therapy. Diabetes therapies are described by their brand names to differentiate new therapies with generic names similar to those of existing therapies and to draw distinctions between separate therapies that share the same generic names.
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