Changing Paradigms in the Pharmacological Management of Type 2 Diabetes

Preface

If we could only choose one word to describe the term “the pharmacological management of type 2 diabetes,” that word would likely be “change.” Not just singular change, but change on many fronts, including the introduction of novel agents, new methods of delivery, new treatment goals, and new means of monitoring effectiveness.

As Winston Churchill once said, “There is nothing wrong with change if it is in the right direction.” From this perspective, an honest assessment would lead us to the conclusion that in this arena, some of the changes that have occurred in the past three or four decades have been positive, whereas others have been negative.

A dramatic change in the incidence and prevalence of type 2 diabetes has led to the use of the term “epidemic” when referring to the change in frequency of type 2 diabetes.¹ There has also been an impressive change in the pharmacological agents used in the management of type 2 diabetes since the 1970s; many novel compounds and new insulin formulations have been brought to market.² This obviously has been a positive change. Additionally, the treatment goals for those with type 2 diabetes have evolved with the increased use of blood glucose monitoring (both fasting and postprandial), A1C testing, and recognition of the importance of controlling comorbidities such as hypertension and hyperlipidemia. Still, there is not complete consensus regarding these goals, which can sometimes cause confusion.

Time has also witnessed a change in the method of health care delivery in the United States. Our system has evolved from a basic “fee-for-service” model to an administrative quagmire of myriad third-party payers, with many uninsured patients existing on the fringes and lacking access to adequate health care. Although our pharmacological methods of treatment have become more sophisticated and efficacious, they have also …