New drugs for diabetes -- pausing for thought.

We now have 2 years' experience of exenatide and sitagliptin, drugs for type 2 diabetes that work by mimicking and enhancing endogenous gut hormones respectively. In terms of blood glucose lowering, they are similar in potency to other classes of agent but offer the advantages of a low risk of hypoglycaemia and facilitation of weight management. They are used as second- and third-line drugs in the management of blood glucose in type 2 diabetes but are not licensed for use with insulin. There is much excitement about the potential of exenatide in promoting weight loss, and its use outside its current licensing is examined. Disadvantages of exenatide include its subcutaneous administration, nausea, vomiting and reports of acute pancreatitis. Sitagliptin (and the more recently introduced vildagliptin) are taken orally and cause less nausea but have less impact on weight and glycated haemoglobin level. As with all new drugs for diabetes, careful post-marketing surveillance is required, especially for cardiovascular events but also for the unexpected. National Institute for Health and Clinical Excellence guidance on the use of these drugs has now been updated and is summarised. [ABSTRACT FROM AUTHOR]