Antidiabetic treatment modalities in Type 2 diabetes mellitus

Abstract

Main mechanisms leading to hyperglycemia in type 2 diabetes mellitus (T2DM) are: increased glucose production in the liver, insulin resistance in muscle and adipose tissue, progressive decrease in insulin secretion from the pancreas and hormonal disorders like increased amylin release from beta cells, increased glucagon release from alpha cells and disorders in incretin hormone secretion. Different pathophysiological mechanisms of the disease lead to the development of many different antidiabetic drugs acting via different actions to overcome these mechanisms to control hyperglycemia. Diabetes ceased to be a fatal disease with the discovery of insulin in 1921. Advances in insulin and non-insulin antidiabetic medications have extended life expectancy after diagnosis in people with diabetes. Diet, exercise, and diabetes education are crucial components of diabetes management. Although insulin is the only treatment option for type 1 diabetes, the treatment choices may differ in newly diagnosed patients with T2DM according to patient characteristics. The fundamental principles of antidiabetic treatment in T2DM patients are: achieving glycemic control targets, considering patient characteristics in treatment selection and considering the effectiveness and side effects of antidiabetic drugs. A recent approach to antidiabetic drug treatment emphasises the importance of initiating complementary, patient-specific combination therapies promptly, rather than the traditional stepwise approach. Patient and disease-related factors in setting glycemic targets and selecting treatments can be summarised as follows: risk of hypoglycemia, duration of diabetes, life expectancy, comorbidities, and vascular complications. The patient demand, as well as resources and support systems, may be considered in certain circumstances.