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as reducing body weight, blood pressure and major CV risk factors.
Other agents in clinical development offer a variety of novel modes of
action, some which even target the pathogenesis of T2DM. The arrival
of new drugs onto the market is widely anticipated. However, the en-
thusiasm for using new therapies needs to be tempered with data that
validates the safe and effective use of these agents in T2DM.

Chapter 5 Summary

z Glycaemic control should take into account FPG and PPG as well as HbA .
1c
z The effect of treatment on body weight, hypertension, lipidaemia and other
CV risk factors is also very important.

z Treatment adherence may be improved by better tolerability and reduced
pill burden.
z The importance of co-morbidities (e.g. renal impairment) are often
neglected in treatment decisions.

z T2DM treatment requires regular adjustment and a deliberate treat-to-target
strategy.
z Intensive management increases the cost of treatment, but can reduce the
cost of complications considerably as well as increasing the time free of
complications.

z Debate continues regarding the effect of intensive versus conventional
glucose control on the risk of CV events, although a number of large studies
will shed more light on this subject.
z Emerging treatments will be useful in addressing the unmet needs in T2DM
management:
◦ Incretin therapies have been shown to have positive effects on lipid-
aemia.
◦ The SGLT-2 inhibitors can reduce weight and blood pressure –
important CV risk factors.
◦ Incretin therapies are weight neutral or are associated with significant
weight loss.
◦ Metformin appears to reduce the risk of cancer, while drugs that elicit an
increase in circulating insulin levels (SUs, insulin) may have the opposite
effect.
z Metformin will most likely remain the gold standard in T2DM management.

z New treatments, such as those targeting the incretin system may become
increasingly important, especially in combination therapy.
z Advances in our understanding of the disease, its treatment and the needs
of the patient will drive the individualisation of T2DM therapy.

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