Glucose Lowering Treatment Modalities of Type 2 Diabetes Mellitus
This chapter gives an overview of present knowledge and clinical aspects of antidiabetic drugs according to the recently available research evidence and clinical expertise.
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Glucose Lowering Treatment Modalities of Type 2 Diabetes Mellitus Asena Gökçay Canpolat and Mustafa Şahin
Abstract
Keywords
This chapter gives an overview of present knowledge and clinical aspects of antidiabetic drugs according to the recently available research evidence and clinical expertise. Many agents are acting on eight groups of pathophysiological mechanisms, which is commonly called as “Ominous Octet” by DeFronzo. The muscle, liver and β-cell, the fat cell, gastrointestinal tract, α-cell, kidney, and brain play essential roles in the development of glucose intolerance in type 2 diabetic individuals (Defronzo, Diabetes 58:773–795, 2009). A treatment paradigm shift is seen in the initiation of anti-hyperglycemic agents from old friends (meglitinides or sulphonylürea) to newer agents effecting on GLP-1 RA or SGLT-2 inhibitors. It is mostly about the other protective positive effects of these agents for kidney, heart, etc. Although there are concerns for the long term safety profiles; they are used widely around the World. The delivery of patient-centered care, facilitating medication adherence, the importance of weight loss in obese patients, the importance of co-morbid conditions are the mainstays of selecting the optimal agent.
Acarbose · Dipeptidyl peptidase 4 inhibitors · Glucagon-like peptide 1 receptor agonists · Glucose-lowering therapies · Meglitinides · Metformin · Sodium-glucose transporter two inhibitors · Sulphonylurea · Thiazolidinediones
A. Gökçay Canpolat and M. Şahin (*) Department of Endocrinology and Metabolism, Ankara University School of Medicine, Ankara, Turkey e-mail: [email protected]; Mustafa. [email protected]; [email protected]
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Introduction
Diabetes mellitus (DM) is a chronic metabolic disease associated with the metabolism of carbohydrates, fats, and proteins due to insulin deficiency or insulin resistance. The treatment strategy of DM has to be based on the knowledge of its pathophysiology. The general goals of the treatment of DM are to provide glycemic control, avoid acute complications, prevent or delay the appearance of chronic complications of the disease, and thus to improve the quality of life. The management of type 2 DM also includes managing conditions associated with T2DM, such as obesity, hypertension, dyslipidemia, and cardiovascular disease. Obesity, hypertension, and diabetes are increasingly common epidemics worldwide. What can be the reason for this incredible increase? Since a change in our genes can not explain this increase in such a short time, we can say that the cause is environmental and epigenetic. Western diet, endocrine disrupters, processed food, changes in microbiota,
A. Gökçay Canpolat and M. Şahin
technology itself, increased sugar consumption, inactivity, and stress are the leading causes of this outbreak. According to the 9th edition of new IDF atlas, 463 million adults are currently living with dia
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