论文部分内容阅读
The first paradigm change in the treatment of diabetes was the isolation and administration of insulin by Banting and Best, changing type 1 diabetes from a terminal to a treatable condition.The treatment paradigm for type 2 diabetes during the 20th century centered around the optimizing of glycaemic control, monitored either by blood glucose monitoring or by biochemical markers of longer term control.This paradigm paid little attention to the continuing pathophysiology of type 2 diabetes and the contribution to this by pharmacological interventions.One reason for this was the lack of treatments which addressed the underlying pathophysiology with acceptable clinical effectiveness.The introduction ofDDP-4 Inhibitors and GLP-1 analogues offers clinicians new, effective agents to achieve glycaemic control.More importantly, however, they offer the opportunity to develop a new paradigm for the management of type 2 diabetes centered around its underlying mechanisms.This should lead to better short and long-term clinical outcomes for patients and the healthcare society in general.This presentation outlines the evidence for this paradigm change, its potential for present and future treatment of type 2 diabetes within and without the confines ofpharmacotherapy, and suggests at some of the obstacles which may prevent the full optimization of this opportunity.