Table 3 Summary of newer agents for the treatment of type 2 diabetes mellitus
| Drug | Class | Dose | Benefits | HbA1c reduction | Problems/cautions | Clinical use |
| Exenatide | GLP-1 agonist | 5 μg twice daily increasing to 10 μg twice daily after 12 weeks | Weight reductionβ cell preservation in animal studiesSuppresses appetite | −0.4% to −1.11% | Gastrointestinal side effectsSubcutaneous injections | Used with metformin or sulfonylurea alone or in combination with both |
| Sitagliptin | DPP-IV inhibitor | 100 mg once daily | Targets prandial and fasting glucose levelsImproves markers of β cell functionWell tolerated by most | −0.3% to −1.1% | Renal impairmentCan potentiate digoxin | Can be used with metformin, sulfonylurea or TZD. Can be used in triple combination with metformin and sulfonylurea |
| Vildagliptin | DPP-IV inhibitor | 50 mg once daily | −0.48% to −2.07% | Not recommended for use in those with hepatic impairment | Still unapproved by the FDA. Can be used with metformin, sulfonylurea or TZD | |
| Rimonabant | Endocannabinoid receptor blocker | 20 mg once daily before breakfast | Weight lossImproved insulin sensitivitySuppresses appetite | −0.1% to −0.6% | Associated with depressive mood disorders. Concomitant antidepressants are a contraindicationSide effects: upper respiratory tract infections, nausea, vomiting, diarrhoea | Used at any stage of treatment with other oral hypoglycaemic agents |
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DPP-IV, dipeptidyl peptidase; FDA, US Food and Drug Administration; GLP-1, glucagon-like peptide; TZD, thiazolidinedione.
