Diabetes

reviews

Type 2 diabetes: where we are today: An overview of disease burden, current treatments, and treatment strategies
r. Keith Campbell
Received June 2, 2009, and in revised form August 11, 2009. Accepted for publication August 11, 2009. R. Keith Campbell, BPharm, FASHP, CDE, is Distinguished Professor in Diabetes Care/ Pharmacotherapy, College of Pharmacy, Washington State University,Pullman. Correspondence: R. Keith Campbell, BPharm, FASHP, CDE Dept. of Pharmacotherapy, College of Pharmacy, Washington State University Spokane, PO Box 646510, Pullman, WA 99164-6510. E-mail: rkcamp@ wsu.edu Disclosure: Speakers’ Bureau for Eli Lilly & Co., Daiichi-Sankyo. Otherwise, the author declares no conflicts of interest or financial interests in any product or service mentioned in thisarticle, including grants, employment, gifts, stock holdings, or honoraria. Acknowledgment: AdelphiEden Health Communications and Robert McCarthy, PhD, for medical editorial services. Funding: Publication of the supplement to JAPhA made possible through an educational grant from Novo Nordisk Inc.

Abstract
Objective: To provide an overview of the disease burden and current strategies in thetreatment of patients with type 2 diabetes. Data sources: Medline search of all relevant clinical and review articles. Study selection: By the author. Data extraction: By the author. Data synthesis: The prevalence of diabetes in the United States has reached epidemic proportions with the total diagnosed and undiagnosed cases among people aged 20 years or older estimated at 12.9%, and it continues torise at an alarming rate. This upsurge has been paralleled by an increase in rates of obesity. Type 2 diabetes accounts for up to 95% of diabetes cases and is often comorbid with hypertension and dyslipidemia. Conclusion: Tight glycemic control is necessary for the management of type 2 diabetes, but progressive deterioration of beta-cell function can lead to a loss of glycemic control. Oralantidiabetes drugs and insulin are effective but do not always correct the associated metabolic and glucoregulatory dysfunctions, and hypoglycemia and weight gain are common adverse effects of these agents. A clear need exists for aggressive therapeutic options—particularly incretin-based agents—that can be combined with existing agents to preserve beta-cell function and halt the progression of type 2diabetes. Keywords: Type 2 diabetes, prevalence, beta-cell function, comorbidities, incretins, incretin-based therapies. J Am Pharm Assoc. 2009;49(suppl 1):S3–S9. doi: 10.1331/JAPhA.2009.09077

Journal of the American Pharmacists Association

www.japha.org

S e p /O c t 2009 • 49:5 (S u p p l . 1) •

JAPhA • S3

3

9/3/09 12:17 PM

reviews tyPE 2 DIABEtES OvERvIEW

he prevalence oftype 2 diabetes has increased alarmingly in the United States.1 The American Diabetes Association (ADA) estimates that more than 23 million U.S. adults aged 20 years or older have diabetes (~95% type 2 diabetes).2 Among middle-aged Americans, for example, prevalence of type 2 diabetes has doubled during the past 3 decades.1 Factors contributing to this increased prevalence are obesity, physicalinactivity, and an increase in the number of individuals older than 65 years.3 These factors, and corresponding prevalence of type 2 diabetes, are also in evidence worldwide. The World Health Organization (WHO) has put the number of persons with diabetes worldwide at approximately 170 million, a figure expected to rise to 366 million by 2030.3 In 2005, WHO estimated that 1.6 billion adults worldwidewere overweight and 400 million were obese.4 Obesity, of course, is highly correlated with an increased risk of developing glycemic disorders. Diabetes is also frequently comorbid with hypertension, cardiovascular (CV) disease, and microvascular disorders (e.g., retinopathy, nephropathy, neuropathy), which may result in blindness, nontraumatic limb amputation, and renal failure.5 Current...