Figure 6 includes the most recent addition to the panel of drugs for treating T2DM, the sodium-glucose cotransporter-2 (SGLT-2) inhibitors, approved by the US Food and Drug Administration (FDA) in 2013. The mechanism of action for this class focuses on inhibiting the reabsorption of glucose in the kidney and increasing glucose excretion in the urine, thereby lowering glucose levels in the blood, with a modest HbA_1C-lowering effect. Another effect of SGLT-2 inhibition, through the glucose excretion, is to promote weight loss. SGLT-2 inhibitors are associated with a low incidence of hypoglycemia, they complement the action of other antidiabetic agents, and can be used at any stage of diabetes. Finally, a clear advantage with drugs in this class is that they are administered orally.

The main disadvantage with SGLT-2 inhibitors, based on the increased renal excretion of glucose, has been mycotic infections in both males and females. The other challenge with this new class of T2DM treatment is high cost.

Finally, the oldest antidiabetic agent is, of course, insulin. Insulin directly increases glucose disposal and helps to decrease hepatic glucose production. It is universally effective, and there are few restrictions on the ways clinicians can use insulin. There are also many advantages with this oldest diabetes drug. Both healthcare professionals and patients have a lot of experience with this medication; it can be easily titrated for individual patient use; and it helps decrease microvascular risk, especially when the HbA_1C levels are kept under good control.

At the same time, insulin has several well-known disadvantages. The drug must be injected, which requires some patient training, and many patients may feel that there is some stigma associated with being on insulin. In addition, hypoglycemia is always a risk with insulin injections, and insulin use induces weight gain. Finally, the economic cost of insulin varies widely, depending on whether one is using analogues or non-analogues. Kapustin J. J Nurse Pract. 2014; 00:00 – 00.