History of current non-insulin medications for diabetes mellitus

Abstract

This article is a brief review of the current non-insulin agents for diabetes mellitus in the United States, namely, sulfonylureas, biguanides, thiazolidinediones, meglitinides, α-glucosidase inhibitors, glucacon-like peptide-1 receptor agonists, dipeptidyl-peptidase-4 inhibitors, amylin agonists, bromocriptine, and colesevelam.

A Brief History of the Development of Diabetes Medications

“…10 Five years later, Marcel Janbon and his colleagues were treating patients with the antibiotic para-amino-sulfonamideisopropyl-thiodiazole for typhoid and observed hypoglycemia. 11 In 1946, Auguste Loubatieres confirmed that aryl SU compounds stimulated release of insulin and therefore required some pancreatic β-cell function to elicit an effect. 3,10 In the 1950s, the first SU, tolbutamide, was marketed in Germany.…”

“…A1C reduction from glinides is generally between 1 and 1.5%. 7,11 The first agent in this class, repaglinide, was approved by the FDA in 1997, and a second agent, nateglinide, was approved in 2000. …”

“…These agents had been in use in Europe for several years before this. 11 The next SU agent, glimepiride, which is sometimes referred to as a third-generation agent, was released in 1995.…”

“…3,10 In the 1950s, the first SU, tolbutamide, was marketed in Germany. 11 This was followed by the introduction of the other first-generation agents: chlorpropamide, acetohexamide, and tolazamide. The next advancement in SU therapy in the United States did not occur until the release of the more potent second-generation agents glipizide and glyburide in 1984.…”

“…20 GLP-1 receptor agonists, which are all administered subcutaneously, are generally associated with 0.5-1% reductions in A1C levels. 7,11 Weight loss is one advantage of treatment with incretin-based agents. However, these compounds can cause significant GI side effects, particularly early in therapy, and concerns about associations between GLP-1 receptor agonists and pancreatitis are ongoing.…”