[Current treatment with oral antidiabetic agents].

In the large majority of type 2 diabetics, the initial phase of the disease is characterized by insulin resistance. A primary insulin secretion disorder is seen only in normal-weight patients, and requires a differentiated therapeutic approach. Glinides make possible flexible meal-oriented stimulation of insulin secretion. Insulin resistance can be influenced by insulin sensitizers. In the overweight patient, biguanides (metformin) effectively lower blood sugar, either alone or in combination with other oral antidiabetic agents. Acarbose, and glitazone can delay progression to diabetes. Furthermore, acarbose, biguanides, and in particular glitazone, reduce cardiovascular events. For normal-weight patients, sulfonylureas are considered the first-line drug for monotherapy. Progressive insulin secretion deficiency and usually persistent insulin resistance requires insulin substitution in combination with oral antidiabetic agents or as conventional/intensified insulin therapy.