Management of type 2 diabetes: new and future developments in treatment

Abd A. Tahrani, Clifford J Bailey, Stefano Del Prato, Anthony H. Barnett

Research output: Contribution to journalArticlepeer-review


The increasing prevalence, variable pathogenesis, progressive natural history, and complications of type 2 diabetes emphasise the urgent need for new treatment strategies. Longacting (eg, once weekly) agonists of the glucagon-like-peptide-1 receptor are advanced in development, and they improve prandial insulin secretion, reduce excess glucagon production, and promote satiety. Trials of inhibitors of dipeptidyl peptidase 4, which enhance the effect of endogenous incretin hormones, are also nearing completion. Novel approaches to glycaemic regulation include use of inhibitors of the sodium-glucose cotransporter 2, which increase renal glucose elimination, and inhibitors of 11ß-hydroxysteroid dehydrogenase 1, which reduce the glucocorticoid effects in liver and fat. Insulin-releasing glucokinase activators and pancreatic-G-protein-coupled fatty-acid-receptor agonists, glucagon-receptor antagonists, and metabolic inhibitors of hepatic glucose output are being assessed. Early proof of principle has been shown for compounds that enhance and partly mimic insulin action and replicate some effects of bariatric surgery.
Original languageEnglish
Pages (from-to)182-197
Number of pages16
JournalThe Lancet
Issue number9786
Early online date24 Jun 2011
Publication statusPublished - 9 Jul 2011


  • 11-beta-hydroxysteroid dehydrogenase type 1
  • allylamine
  • anticholesteremic agents
  • bariatric surgery
  • bile acids and salts
  • cardiovascular system
  • comorbidity
  • type 2 diabetes mellitus
  • dipeptidyl-peptidase IV inhibitors
  • glucagon-like peptide 1
  • glucokinase
  • humans
  • hyperglycemia
  • hypoglycemic agents
  • indoles
  • insulin
  • insulin resistance
  • insulin-secreting cells
  • liver
  • obesity
  • peptides
  • randomized controlled trials as topic
  • dopamine D2 receptors
  • signal transduction
  • sodium-glucose transporter 2
  • treatment outcome
  • venoms


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