Initially, therapy for diabetes includes special diets to reduce carbohydrate intake and thus blood glucose and weight reduction. Anti-diabetic drugs are the next of course of action.
A. Drugs
1. Drugs to Increase Insulin Production by the Pancreas
Included in this group are the sulfonylureas such as glyburide, glipizide, gliclazide, and glibenclamide. These agents have been used for more than 50 years. The well-known agents used in the 1950s, tolbutamide and chlor-propamide, have been replaced by the new agents listed above. Several other agents are now available, but they are far superior to the old agents. Additionally, sulfonylureas are relatively ineffective drugs because they are not able to squeeze sufficient insulin from dysfunctional pancreatic beta islet cells. There may also be some cardiotoxic effect with prolonged use. The use of sulfonylureas over the past 30 years has not altered the prognosis of diabetes and its complications (see Fig. 1). Physicians should seek other methods of treatment.
2. Drugs that Appear to Increase Peripheral Uptake of Insulin
One example is metformin. This biguanide is commonly used at a dose of 500 mg twice or three times daily with a maximum dose of 2000 mg daily, but physicians often exceed this maximum dose. Metformin has interesting actions and there is potential for developmental research in this area.

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