Toxicological profile of anti-diabetic drugs and emerging measures to reduce the toxic burden

Diabetes mellitus (DM) is a major public health concern of the 21st century, with global figures of the diabetic population expected to reach approximately 700 million by 2045. In the face of this rapidly increasing trend in global prevalence of DM, various therapeutic strategies have been explored and developed to mitigate this alarming increase. A variety of pharmacological agents are currently in use, ranging from insulin analogs to sodium-glucose co-transporter 2 inhibitors. These therapeutic agents have had varying successes in their hypoglycemic effects. However, some agents have been withdrawn due to life-threatening side effects. Although these agents possess their unique safety and toxicity profiles, their use and efficacy are guided by an individualized approach as determined by specific patient-related factors such as age, genetic susceptibility, and existing comorbidities. This review examines the various major classes of hypoglycemic agents, their associated tissue- and organ-related toxicities as well as emerging measures aimed at reducing their toxicity.