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Review
. 2016 Sep 15;7(17):354-95.
doi: 10.4239/wjd.v7.i17.354.

Update on the treatment of type 2 diabetes mellitus

Juan José Marín-Peñalver  1 , Iciar Martín-Timón  1 , Cristina Sevillano-Collantes  1 , Francisco Javier Del Cañizo-Gómez  1
Affiliations
Review

Update on the treatment of type 2 diabetes mellitus

Juan José Marín-Peñalver et al. World J Diabetes. .

Abstract

To achieve good metabolic control in diabetes and keep long term, a combination of changes in lifestyle and pharmacological treatment is necessary. Achieving near-normal glycated hemoglobin significantly, decreases risk of macrovascular and microvascular complications. At present there are different treatments, both oral and injectable, available for the treatment of type 2 diabetes mellitus (T2DM). Treatment algorithms designed to reduce the development or progression of the complications of diabetes emphasizes the need for good glycaemic control. The aim of this review is to perform an update on the benefits and limitations of different drugs, both current and future, for the treatment of T2DM. Initial intervention should focus on lifestyle changes. Moreover, changes in lifestyle have proven to be beneficial, but for many patients is a complication keep long term. Physicians should be familiar with the different types of existing drugs for the treatment of diabetes and select the most effective, safe and better tolerated by patients. Metformin remains the first choice of treatment for most patients. Other alternative or second-line treatment options should be individualized depending on the characteristics of each patient. This article reviews the treatments available for patients with T2DM, with an emphasis on agents introduced within the last decade.

Keywords: Future treatments; Injectable antidiabetic agents; Older people; Oral antidiabetic agents; Renal impairment; Treatment; Type 2 diabetes mellitus.

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Figures

Figure 1
Figure 1
Global Guidelines for managing older people with type 2 diabetes. International Diabetes Federation[272]. SGLT2: Sodium glucose co-transporter-2; GLP-1: Glucagon-like peptide-1; DDP-4: Dipeptidyl peptidase-4.
Figure 2
Figure 2
Recommendations for use of antidiabetic agents based on estimated glomerular filtration rate. Adapted from Zanchi et al[292]. eGFR: Estimated glomerular filtration rate.
Figure 3
Figure 3
Therapeutic algorithm in patients with type 2 diabetes mellitus and chronic kidney disease. Adapted from Gómez-Huelgas et al[338]. aAvoid Glibenclamide. Use Gliclazide, Glipizide and Gliquidone. Use Glimepiride only if eGFR > 60 mL/min; bDose adjustment, except linagliptin; cMonitor fluid retention; dAdjust doses of exenatide and lixisenatide; eGenerally not use Metformin. Use only half the dose and monitor renal function; fNot recommended if eGFR < 60 mL/min. eGFR: Estimated glomerular filtration rate; HbA1c: Glycated haemoglobin; GLP-1: Glucagon-like peptide-1; SGLT2: Sodium-glucose co-transporter 2; DPP-4: Dypeptydil peptidase-4.
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