Pharmacologic therapy for type 2 diabetes mellitus.

Area of Science:

• Endocrinology
• Metabolic Disorders
• Pharmacology

Background:

• Type 2 diabetes mellitus (T2DM) is a chronic metabolic disorder characterized by impaired insulin secretion and action.
• Hyperglycemia in T2DM stems from elevated hepatic glucose production and reduced glucose uptake by muscles.
• Current treatment involves five classes of oral agents with distinct mechanisms to improve glycemic control.

Purpose of the Study:

• To review the goals of antihyperglycemic therapy in T2DM.
• To examine the mechanism of action, efficacy, and safety of five oral antidiabetic agent classes.
• To provide a rationale for using oral agents in monotherapy and combination therapy.

Main Methods:

• Review of existing literature and clinical trial data, including the UKPDS study.
• Analysis of mechanisms of action for different oral antidiabetic drug classes.
• Evaluation of efficacy, non-glycemic benefits, cost, and safety profiles.

Main Results:

• T2DM is a progressive disorder requiring escalating therapy, potentially including insulin.
• Improved glycemic control, regardless of agent (sulfonylureas, metformin, insulin), reduces microvascular complications.
• Five oral agent classes are available, each with unique properties.

Conclusions:

• Oral antidiabetic agents are crucial for managing T2DM.
• Combination therapy with oral agents and/or insulin is often necessary for achieving glycemic targets.
• Glycemic control is linked to reduced microvascular complications in T2DM.