IN BRIEF This article reviews the evidence regarding the impact of postprandial glucose (PPG) on overall A1C and its relation to cardiovascular disease (CVD). To date, four randomized, controlled trials have evaluated the impact of PPG reduction on CVD; however, only one of these successfully demonstrated a positive effect. Despite this, epidemiological evidence does indicate a cardiovascular benefit of PPG reduction, and agents that can be used to manage PPG in people with type 2 diabetes are also discussed.

IN BRIEF The number of medications used to treat diabetes has increased dramatically in the past 15 years. With so many options that have shown significant A1C improvement, it is important to consider side effects, precautions, and additional benefits these agents may offer. This article is a review of some of the most compelling literature available on the nonglycemic benefits of sulfonylureas, thiazolidinediones, biguanides, glucagon-like peptide 1 receptor agonists, dipeptidyl peptidase 4 inhibitors, and sodium–glucose cotransporter 2 inhibitors. Other classes of antihyperglycemic agents, such as dopamine agonists, meglitinides, and amylin agonists, are not discussed in this article.

IN BRIEF Caring for people with type 2 diabetes requires a patient-centered approach to treatment targets and medication regimens. Focusing on patients’ individual characteristics, needs, and treatment responses can improve compliance and clinical outcomes. Medication selection can be guided by the mechanisms of action, advantages, disadvantages, and costs of available options; patients’ behavioral and psychological variables, personal preferences, and socioeconomic status also should be taken into account. This article provides an overview of patient-centered and individualized diabetes management, offers pharmacological recommendations for specific clinical scenarios, and describes a complicated case illustrating the patient-centered approach in clinical practice.

In Brief Sodium–glucose cotransporter 2 (SGLT2) inhibitors and incretin-based therapies (dipeptidyl peptidase-4 [DPP-4] inhibitors and glucagon-like peptide-1 [GLP-1] receptor agonists) are widely used to treat patients with type 2 diabetes. In clinical and real-world studies, canagliflozin, an SGLT2 inhibitor, has demonstrated superior A1C lowering compared to the DPP-4 inhibitor sitagliptin. Canagliflozin can also promote modest weight/fat loss and blood pressure reduction. The addition of canagliflozin to treatment regimens that include a DPP-4 inhibitor or a GLP-1 receptor agonist has been shown to further improve glycemic control, while still maintaining beneficial effects on cardiometabolic parameters such as body weight and blood pressure. Overall, the available clinical and real-world evidence suggests that canagliflozin is a safe and well-tolerated treatment option that can be considered either in addition to or instead of incretin-based therapies for patients with type 2 diabetes.

In Brief For patients with type 2 diabetes who require add-on therapy to metformin plus basal insulin, GLP-1 receptor agonists may be a favorable option because they effectively manage postprandial glucose, reduce body weight, and have an overall favorable safety profile compared to other agents. Given the wide range of treatment combinations available for type 2 diabetes management, health professionals must partner with patients to determine the best choices based on patients’ individual lifestyle, resources, and treatment goals.

IN BRIEF Although the number of diabetes treatments has substantially increased in the past two decades, today's therapies are considered far from ideal. Yet, what constitutes an ideal therapy is not readily clear, as diabetes drug therapies are regularly judged both by their effects on glycemia and by a wide variety of nonglycemic metrics. This review describes the characteristics of an ideal diabetes therapy from the perspective of patients, physicians, payors, and financial analysts and examines how well currently available therapies and several late-stage candidates meet these guideposts.

IN BRIEF Comparative trials show that there are important differences between and among the glucagon-like peptide-1 (GLP-1) receptor agonists and dipeptidyl peptidase-4 (DPP-4) inhibitors with respect to glycemic lowering, weight effects, and effects on systolic blood pressure and the lipid profile. Nausea, diarrhea, headaches, and dizziness are common with both of the available GLP-1 receptor agonists. Upper respiratory tract infections, nasopharyngitis, and headaches are common with the DPP-4 inhibitors. Ongoing safety evaluations should provide a clear picture regarding long-term safety.

IN BRIEF Sitagliptin is the first agent in a new category of medications, the dipeptidyl peptidase-IV (DPP-IV) inhibitors. It was recently approved in the United States for the management of hyperglycemia in patients with type 2 diabetes; vildagliptin, a second agent in this class, is likely to join it on the U.S. market soon. These compounds accentuate the activity of endogenously produced antihyperglyemic incretin hormones and are generally well tolerated. This article provides an overview of the pharmacology and clinical use of the DPP-IV inhibitors.