Perspectives dans le traitement pharmacologique du diabète de type 2 pour les 10 prochaines années

Type 2 diabetes (T2D) is a complex disease characterized by different pathophysiological mechanisms. None of the available antidiabetic agents is able to target all the underlying abnormalities so that combined therapies are often mandatory. Despite that, numerous patients remain with a poorly controlled T2D, which exposes them to an increased risk of vascular complications. New glucose-lowering compounds are currently in development by the pharmaceutical industry in preclinical or already clinical phases. Some belong to well-known pharmacological classes and should be commercialized in a rather near future. Other combine different approaches that are potentially complementary, either as fixed-dose combinations or with original molecules that exert double, or even triple, activities. While new insulin secretagogues are investigated, an increasing interest is focusing on glucagon. This review describes novel antidiabetic agents at different phases of development: delayed-release metformin, new PPAR agonists, GLP-1 receptor agonists, co-agonists of GLP-1/GIP/glucagon receptors, SGLT2/SGLT1 inhibitors, new insulin-secreting compounds, antagonists of glucagon receptors, anti-obesity agents, innovative anti-inflammatory compounds. If some of these new antidiabetic medications arrive on the market within the next 10 years, they should demonstrate an added value compared to already available glucose-lowering agents, be at best integrated within the therapeutic algorithms, and have a reasonable prize allowing reimbursement.