New drugs in diabetes

The field of diabetes has witnessed the development of new therapeutic agents with novel mechanisms of action. This article describes four drugs which have the potential for revolutionizing the management of type 2 diabetes in the future. Colesevelam is a bile acid sequestrant, which is unique in reducing both LDL cholesterol and hyperglycaemia, when used in combination with metformin, sulphonylurea and insulin. Additionally, it is effective in patients with prediabetes and hypercholesterolaemia. Hypoglycaemia and weight gain are not observed with colesevelam. Bromocriptine mesylate is a timed release dopamine D2 receptor agonist which restores the dopaminergic tone within the central nervous system (CNS). It reduces plasma glucose, triglyceride and free fatty acid (FFA) levels. Additionally cycloset decreased the cardiovascular composite end point by 40%. The drug has to be taken within 2 hours of awakening. Dapagliflozin is a selective sodium-glucose co-transporter 2 (SGLT2) inhibitor which increases urinary glucose excretion resulting in net caloric loss. It reduces both weight and blood pressure. But dapagliflozintreated patients reported an increase in events suggestive of genital infections and lower urinary tract infections (UTIs), which needs further evaluation. Glucokinase (GK) which is involved in the first step in glycolysis, exhibits two different actions in pancreas and liver leading to increased insulin secretion and glycogen synthesis respectively. Glucokinase activators (GKAs) increase the affinity of GK for glucose by ten fold. Long term clinical trials are needed to evaluate the safety of this novel drug.