Newer agents for blood glucose control in type 2 diabetes: summary of NICE guidance

Abstract

Management of type 2 diabetes is complex and aims to prevent and reduce the impact of complications by encouraging a healthy lifestyle, controlling blood pressure and blood lipids, and lowering blood glucose concentrations. In recent years new drugs have become available for blood glucose control, including the long acting insulin analogues (insulin detemir and insulin glargine); glucagon-like peptide-1 (GLP-1) mimetics (exenatide); and dipeptidylpeptidase-4 (DPP-4) inhibitors (sitagliptin and vildagliptin). In addition, safety concerns have surfaced recently about the use of the thiazolidinediones (pioglitazone and rosiglitazone). This article summarises the most recent recommendations from the National Institute for Health and Clinical Excellence (NICE) on the use of newer agents for control of blood glucose in type 2 diabetes1 and updates the relevant section of the NICE clinical guideline on the management of type 2 diabetes.2 NICE recommendations are based on systematic reviews of best available evidence. When minimal evidence is available, recommendations are based on the Guideline Development Group’s experience and opinion of what constitutes good practice. Evidence levels for the recommendations are given in italic in square brackets. ### DPP-4 inhibitors and thiazolidinediones DPP-4 inhibitors stabilise concentrations of endogenous glucagon-like peptide and increase insulin secretion. [ Based on evidence ranging from low to moderate quality from randomised controlled trials; a meta-analysis; current NICE guidance 2 ; and a health economic analysis ]