Antidiabetic drugs other than insulins

Abstract

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.