Pharmacotherapy in type 2 diabetes: a functional schema for drug classification

Area of Science:

• Endocrinology
• Pharmacology

Background:

• Long-term hyperglycemia contributes to diabetes-related tissue damage.
• Intensive treatment strategies, often involving combination diabetes drugs, are increasingly used to achieve euglycemia (normal blood glucose levels).

Purpose of the Study:

• To propose a classification schema for diabetes drugs based on their mechanisms of action.
• To guide rational combination therapy for managing hyperglycemia.

Main Methods:

• Literature survey of contemporary and historical texts on hyperglycemia toxicity and treatment strategies.
• Selection of references for clinical applicability and drug mechanism explanation.
• Development of a drug classification system.

Main Results:

• Diabetes drugs are categorized into insulin providers (exogenous insulin, secretagogues like sulfonylureas/meglitinides, and incretin-based therapies like GLP-1 analogues/DPP-4 inhibitors), insulin sensitizers (metformin, thiazolidinediones), and insulin-independent drugs (alpha-glucosidase inhibitors, SGLT2 inhibitors).
• This classification facilitates understanding of how different drug classes address hyperglycemia through distinct pathways.

Conclusions:

• A clear classification of diabetes drugs aids in selecting rational drug combinations.
• Targeting hyperglycemia from multiple directions, guided by drug mechanisms, aligns with current treatment guidelines.