Challenges Related to Glycemic Control in Type 2 Diabetes Mellitus Patients

Diabetes mellitus (DM) is a chronic disease with long-term complications. Glycemic control is an important part in management of DM. The first line in treatment of type 2 DM (T2DM) is diet and life style change. Metformin is the first choice of medication in T2DM patients. Sulfonylureas have high risk of hypoglycemia. Glinides are associated with lower risk of hypoglycemia in comparison to sulfonylureas. Also, α-glucosidase inhibitors decrease the polysaccharides' digestion in small intestine and are less effective in comparison to metformin and sulfonylureas in lowering hemoglobin A1c (HbA1c). These have no risk for hypoglycemia, but gastrointestinal symptoms are common. Thiazolidinediones are known as insulin sensitizers and are effective for a longer duration in comparison to sulfonylureas, however, have side effects such as fluid retention, edema and heart failure. Incretin mimetics including exenatide and liraglutide act through increase in insulin secretion by pancreatic beta cells, in a glucose-dependent manner. Therefore, these are associated with no risk of hypoglycemia. Pramlintide is an amylin agonist which is also effective in lowering postprandial blood glucose. Sitagliptin and vildagliptin are dipeptidyl peptidase-4 inhibitors and have no risk of hypoglycemia when used as monotherapy. Canagliflozin and dapagliflozin decrease blood glucose level by increasing urinary glucose excretion and are associated with weight loss.