Medications for type 2 diabetes: how will we be treating patients in 50 years?

Abstract

The past 50 years have seen the development of many new options for treating and preventing type 2 diabetes. Despite this success, the individual and societal burden of the disease continues unabated. Thus, the next 50 years will be critical if we are going to quell the major non-communicable disease of our time. The knowledge we will gain in the next few years from clinical studies will inform treatment guidelines with regard to which agents to use in whom and whether more aggressive approaches can slow the development of hyperglycaemia in those at high risk. Beyond that, we anticipate identification of novel targets and techniques for therapeutic intervention. These advances will lead to more personalised approaches to treatment. Most importantly, we will need to focus our political and economic efforts on enhancing and implementing public health approaches aimed at prevention of diabetes and its co-morbidities. This is one of a series of commentaries under the banner '50 years forward', giving personal opinions on future perspectives in diabetes, to celebrate the 50th anniversary of Diabetologia (1965-2015).

Fig. 1

Currently available glucose-lowering medications and future targets subdivided by the organ system in which they have their primary effect. Medications with their general mode of action that were developed before 2015 are listed above the organs, while currently identified future medications (black text) and targets (red text) with their general mode of action are listed below the organs. It is anticipated that over the next 50 years many more targets will be identified. CPT1A, carnitine palmitoyltransferase 1A; FGF21, fibroblast growth factor 21; FOXO1, forkhead box protein O1; GI, gastrointestinal; HSD11β1, 11β-hydroxysteroid dehydrogenase type 1; SIRT1, sirtuin 1; PTPN1, protein tyrosine phosphatase, non-receptor type 1