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.
Keywords: Type 2 Diabetes Mellitus (T2DM), glycemic control, insulin, metformin, sulfonylureas, thiazolidinediones.
Rights & PermissionsPrintExport