Drugs & Aging

, Volume 4, Issue 6, pp 470–491 | Cite as

Treatment of Non-Insulin-Dependent Diabetes Mellitus and its Complications

A State of the Art Review
  • Aldo Ilarde
  • Michael Tuck
Review Article Drug Therapy


Non-insulin-dependent diabetes mellitus (NIDDM) is a major health problem which occurs predominantly in the older population; 16.8% of persons over age 65 years have NIDDM. The total health costs of NIDDM are in excess of $US20 billion annually.

The primary objective in the treatment of NIDDM is to achieve normoglycaemia, without aggravating coexisting abnormalities. Common abnormalities include obesity, hypertension, retinopathy, nephropathy and neuropathies.

Diet, and consequent bodyweight reduction, is the cornerstone of therapy for NIDDM. Total calorie intake should be limited, while the percentage of calories from carbohydrates should be increased and that from fats and cholesterol should be decreased. Exercise may also help to reduce bodyweight.

Sulphonylurea drugs stimulate insulin secretion from β-cells, and may be a useful adjunct to nonpharmacological therapy. Failure to respond to sulphonylurea drugs may be primary (25 to 30% of initially treated patients) or secondary (5 to 10% per year). It is not clear which is the most effective pharmacological intervention in such cases. Options include switching to or combining therapy with insulin, a biguanide, or other insulin-sparing antihyperglycaemic agents, e.g. α-glucosidase inhibitors, thiazolidinediones, chloroquine or hydroxychloroquine, or fibric acid derivatives such as clofibrate. Other experimental agents include the fatty acid oxidation inhibitors and dichloroacetate.

Specific agents, such as antihypertensives, lipid lowering agents and sorbitol inhibitors, may be needed to prevent the complications arising from the spectrum of clinical and metabolic abnormalities which arise from insulin resistance.


Metformin Diabetic Nephropathy Diabetic Retinopathy Sulphonylureas Glipizide 
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Copyright information

© Adis International Limited 1994

Authors and Affiliations

  • Aldo Ilarde
    • 1
  • Michael Tuck
    • 2
    • 3
  1. 1.San Fernando Valley Medical ProgramUniversity of CaliforniaSepulvedaUSA
  2. 2.Veterans Administration Medical CenterSepulvedaUSA
  3. 3.Department of MedicineUniversity of CaliforniaLos AngelesUSA

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