The role of colesevelam HCl in type 2 diabetes mellitus therapy.

Colesevelam hydrochloride (HCl) was approved in January 2008 as an adjunct therapy for improving glycemic control in patients with type 2 diabetes mellitus (T2DM). Colesevelam HCl is a bile acid sequestrant that has been shown to significantly improve both glycemic control and the lipid profile in patients with T2DM when added to metformin-, sulfonylurea-, or insulin-based therapy. In addition, colesevelam HCl may be useful for reducing glucose and low-density lipoprotein cholesterol levels in patients with prediabetes (defined as fasting plasma glucose levels of 100-125 mg/dL or 2-hour poststimulation glucose levels of 140-199 mg/dL), who have an increased cardiovascular risk. As colesevelam HCl is a unique agent-with both significant glycemic and lipid benefits-it has the potential to play an important role in the management of T2DM. This article reviews the place of colesevelam HCl in therapy (both for T2DM and prediabetes), the benefits of early, intensive treatment of T2DM, and the importance of safe glycemic control later in the disease process.