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Basic aspects of antidiabetic drugs and treatment in type 2 diabetes mellitus
(Bursa Uludağ Üniversitesi, 2025-12) İmamoğlu, Şazi; Gül , Özen Öz; Özyardımcı Ersoy, Canan; Cander, Soner; Ersoy, Alparslan; Tıp Fakültesi; İç Hastalıkları Ana Bilim Dalı; Endokrinoloji ve Metabolizma Hastalıkları Bilim Dalı; 0000-0002-9610-5880; 0000-0002-1332-4165
Diabetes mellitus is a growing health problem worldwide. Physicians working in different fields and branches of medicine meet diabetic patients in their daily practices. Therefore, they should be aware of the treatment facilities, mechanisms of action, clinical use, effects and side effects of medications concerning diabetes mellitus. With the introduction of new oral and injectable agents and insulin therapies for the treatment of type 2 diabetes mellitus, it has been observed that conscious treatments with these drugs are effective in preventing diabetic complications. It is of great importance to understand the positive and negative effects of medications in terms of their effectiveness in treatment. In this book, we aim to share with you what is essential to know and consider when treating type 2 diabetes mellitus, including current medications and treatment approaches in the context of research, guidelines, and practical experiences. With the hope that this book will be helpful for all readers.
Antidiabetic drugs other than insulins
(2025-12) İmamoğlu, Şazi; Gül , Özen Öz; Tıp Fakültesi; Endokrinoloji ve Metabolizma Hastalıkları Bilim Dalı; 0000-0002-1332-4165
Type 2 diabetes mellitus (T2DM) treatment should be based on the determination of patient-centered goals and risk management. Lifestyle management from the time of diagnosis, regulation of medication, diabetes education and motivational interviewing are vital strategies. Treatment adjustment should be carried out by assessing hyperglycemia, risk of hypoglycemia, body weight status, cardiovascular and renal complications, and other problems. In addition to its glucose-lowering properties, the drug of choice for antidiabetic therapy should also be considered for its side effect profile, preference for use in special patient groups, safety and tolerability. Because T2DM is a progressive disease, combination therapy is often required to maintain glycemic targets. Combination therapy should not be delayed in patients who cannot achieve their treatment goals. The selection of the drug to be added in combination therapy should take into account the clinical characteristics of the patient (risk of hypoglycemia, atherosclerotic cardiovascular disease, heart failure, chronic kidney disease/failure, obesity, non-alcoholic steatohepatitis/liver disease and other co-morbidities) and drug side effects. Drugs with different mechanisms of action should be combined to keep glycemia at target and treatment intensification should not be delayed. The mechanisms of action of non-insulin antidiabetic drugs are shown in Table 1. The advantage of this method is to benefit from the potential benefits of added drugs in preventing/delaying diabetes complications, evaluating their favourable/adverse effects and reducing side effects.
Insulins
(Bursa Uludağ Üniversitesi, 2025-12) İmamoğlu, Şazi; Cander , Soner; Tıp Fakültesi; İç Hastalıkları Ana Bilim Dalı; Endokrinoloji ve Metabolizma Hastalıkları Bilim Dalı; 0000-0001-6303-7896
In healthy individuals, insulin secretion from the pancreatic beta cells (endogenous) varies throughout the day according to plasma glucose concentration and the behavior of hormones acting on glucose metabolism. By dividing and examining endogenous insulin secretion into two periods, prandial and basal secretions, the insulin treatments for type 2 diabetes mellitus (T2DM) can be determined. Prandial secretion: Rapid and peak insulin secretion (prandial/bolus secretion) in the pancreas in the prandial/early postprandial period prevents postprandial blood glucose from rising above physiological limits. In treating T2DM patients requiring insulin therapy, rapid/shortacting insulins are administered for prandial secretion. Prandial insulin doses consist of two components: insulin (feeding dose) required to keep glucose elevations within physiological limits after meals and insulin needed to correct if the glucose level detected before meals is higher than the target (correction dose). Basal secretion: Non-peaked secretion (basal secretion) regulates hepatic glucose production and glucose metabolism in skeletal muscle and fatty tissues and controls blood glucose levels during fasting periods. In treating T2DM patients who require insulin therapy, medium/long/very long acting insulins are administered for basal secretion. In this section, different insulins used for the treatment of diabetes will be discussed.
Antidiabetic treatment modalities in Type 2 diabetes mellitus
(Bursa Uludağ Üniversitesi, 2025-12) Ersoy , Canan Özyardımcı; Tıp Fakültesi; İç Hastalıları Ana Bilim Dalı; Endokrinoloji ve Metabolizma Hastalıkları Bilim Dalı
Main mechanisms leading to hyperglycemia in type 2 diabetes mellitus (T2DM) are: increased glucose production in the liver, insulin resistance in muscle and adipose tissue, progressive decrease in insulin secretion from the pancreas and hormonal disorders like increased amylin release from beta cells, increased glucagon release from alpha cells and disorders in incretin hormone secretion. Different pathophysiological mechanisms of the disease lead to the development of many different antidiabetic drugs acting via different actions to overcome these mechanisms to control hyperglycemia. Diabetes ceased to be a fatal disease with the discovery of insulin in 1921. Advances in insulin and non-insulin antidiabetic medications have extended life expectancy after diagnosis in people with diabetes. Diet, exercise, and diabetes education are crucial components of diabetes management. Although insulin is the only treatment option for type 1 diabetes, the treatment choices may differ in newly diagnosed patients with T2DM according to patient characteristics. The fundamental principles of antidiabetic treatment in T2DM patients are: achieving glycemic control targets, considering patient characteristics in treatment selection and considering the effectiveness and side effects of antidiabetic drugs. A recent approach to antidiabetic drug treatment emphasises the importance of initiating complementary, patient-specific combination therapies promptly, rather than the traditional stepwise approach. Patient and disease-related factors in setting glycemic targets and selecting treatments can be summarised as follows: risk of hypoglycemia, duration of diabetes, life expectancy, comorbidities, and vascular complications. The patient demand, as well as resources and support systems, may be considered in certain circumstances.