2019 Volume 65 Issue 6 Pages 517-523
The prevalence of patients with type 2 diabetes mellitus (T2DM) continues to increase. One primary concern in the patients with T2DM is the development of various complications, including retinopathy, nephropathy, neuropathy, myocardial infarction, and stroke; their prevention is the main treatment goal in T2DM. Furthermore, the frequencies of dementia, sarcopenia, and cancer are also higher in elderly patients with T2DM. Numerous clinical trials reveal that improving glycemic control can mitigate complications. In addition, hypoglycemia is associated with increased rates of dementia and cardiovascular death.
Over the last several decades, the treatment strategies for T2DM have changed with the improved understanding of the underlying pathophysiology and the development of many glucose-lowering drugs. Sulfonylureas and glinides promote the secretion of insulin, α-glucosidase inhibitors suppress the absorption of glucose from the intestinal tract, biguanides suppress the hepatic production of glucose, and thiazolidinediones improve the action of insulin in the liver and muscles. Additionally, dipeptidyl peptidase-4 inhibitors and glucagon like peptide-1 receptor agonists promote the secretion of insulin in a glucose-dependent manner, whereas sodium glucose cotransporter 2 inhibitors reduce glucose reabsorption in the proximal renal tubules and urinary glucose excretion. Sulfonylureas are prone to precipitate hypoglycemia in patients with renal dysfunction. It is important for patients to understand the symptoms of hypoglycemia for appropriate resolution.
Appropriate selection of glucose-lowering drugs based on the condition of the individual patient is necessary for better control of the onset and the progression of complications and to achieve better glycemic control without causing hypoglycemia.
