Every year since 1995, a new class of drugs for lowering blood sugar has been developed. At a recent press briefing on advances in diabetes treatment sponsored by the American Medical Association, Dr. John Buse of the University of North Carolina School of Medicine told science writers that such new medications, along with advances in blood glucose monitoring and patient education, have given people with diabetes “new freedom to manage their blood sugar and better control their diabetes.” He added, “at least theoretically, everybody in the U.S. can have excellent blood sugar control” due to these innovations in diabetes management.

These new drugs represent different approaches to treating diabetes and the metabolic irregularities that come with it. The older drugs increased the insulin available to the body by replacing it via an insulin shot or by stimulating the body to produce more, as the sulfonylureas do. The newer agents work differently. Some help the body use insulin more efficiently, while others block the breakdown of starches and certain sugars. The new classes are:

• Biguanides, such as Glucophage®, works in the liver to improve the natural response of the liver to insulin, which is to prevent excessive release of glucose into the blood.

• Alpha-glucose inhibitors, such as Precose® and Glyset®, delay the absorption of sugar into the blood from the intestines and thereby help prevent the sudden surges of glucose that occur after eating.

• Thiazolidinediones, such as Actos® and Avandia®, work by decreasing the body’s resistance to insulin, improving its action in muscle and in fat to store glucose.

• Meglitinides, such as Prandin®, stimulates the pancreas to produce sudden surges of insulin.

• D-phenylalanine derivatives, the newest class, stimulate rapid insulin secretion to reduce the increases in blood glucose levels that occur soon after eating. FDA recently approved the only drug in this class, Starlix® (see box.)