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New directions in type 2 diabetes mellitus: an update of current oral antidiabetic therapy
1Division of Diabetes, Endocrinology and Metabolism, Weill Medical College of Cornell University, New York, NY, USA.
Abstract:
This article reviewed the relevant literature including published clinical trials and reviews on currently available oral hypoglycemic agents. Results showed that the benefits of glycemic control have been established through multiple clinical trials. Long-term control of blood glucose levels in type 1 and type 2 diabetic patients will decrease the incidence and prolong the time until progression of diabetic retinopathy, nephropathy, and neuropathy. Our increased understanding of the pathophysiology behind type 2 diabetes has led to the development of many new agents that are aimed at treating the underlying insulin resistance and relative insulinopenia. The sulfonylureas as a group have been used for many years and act by stimulating insulin secretion. They are useful alone or as combination therapy with insulin or another oral hypoglycemic agent. The biguanides act by decreasing hepatic glucose production and by increasing peripheral insulin sensitivity. The alpha-glucosidase inhibitors act nonsystemically by blocking the metabolism of digested polysaccharides and therefore lowering the amount of carbohydrate absorbed in a meal. Benzoic acid derivatives act in a manner similar to that of sulfonylureas by enhancing pancreatic insulin production. They offer a shorter duration of action, lowering the risk of hypoglycemia. The thiazolidinediones increase peripheral insulin sensitivity and are effective as both monotherapy and combination therapy. Oral hypoglycemic agents, when properly administered, are very effective in controlling type 2 diabetes and preventing long-term complications.
Insights
Effective glycemic control using oral hypoglycemic agents is crucial for managing type 1 and type 2 diabetes. These medications help prevent long-term diabetic complications like retinopathy, nephropathy, and neuropathy.
Area of Science:
- Endocrinology
- Pharmacology
Background:
- Glycemic control is vital for managing diabetes mellitus.
- Understanding the pathophysiology of type 2 diabetes has spurred the development of novel therapeutic agents.
- Oral hypoglycemic agents (OHAs) are a cornerstone in diabetes management.
Purpose of the Study:
- To review current literature on available oral hypoglycemic agents.
- To summarize the benefits of glycemic control in diabetic patients.
- To discuss the mechanisms of action for various classes of OHAs.
Main Methods:
- Literature review of published clinical trials and reviews.
- Analysis of data on the efficacy and safety of OHAs.
- Synthesis of information on the pathophysiology of diabetes and OHA mechanisms.
Main Results:
- Glycemic control significantly reduces the incidence and progression of diabetic microvascular complications (retinopathy, nephropathy, neuropathy).
- Various OHA classes, including sulfonylureas, biguanides, alpha-glucosidase inhibitors, benzoic acid derivatives, and thiazolidinediones, offer distinct mechanisms for glucose lowering.
- OHAs are effective in monotherapy or combination therapy for type 2 diabetes management.
Conclusions:
- Proper administration of oral hypoglycemic agents is highly effective for controlling type 2 diabetes.
- Long-term glycemic control with OHAs is essential for preventing severe diabetic complications.
- The diverse mechanisms of OHAs allow for tailored treatment strategies in diabetes management.