1-In patients with type 2 diabetes, first-line therapy involves advice about dietary and lifestyle modification. Oral anti-diabetic drugs are usually added in those who do not achieve glycaemic targets as a result, or who have severe (8). symptomatic hyperglycaemia at diagnosis and a high HbA1c 2-However, the guidelines in some countries are to introduce medication immediately upon diagnosis of diabetes (8). 4 lists classes of drugs for type 2 DM (6). 3-A reasonable treatment algorithm for initial therapy uses metformin as initial therapy because of its efficacy, known side-effect profile, and relatively low cost Metformin has the advantage that and (Fig. 1). it promotes mild weight loss, improves the lipid profile slightly (9). However, type 2 DM is a progressive disorder and ultimately requires multiple therapeutic agents and often insulin (9). Table 4 :classes of drugs for type 2 DM Drug Type Examples Biguanides Metformin Sulfonylureas Glipizide , Glimepiride Glibenclamide Dipeptidyl peptidase IV Sitagliptin , Saxagliptin, Linagliptin, (DPP-IV) inhibitors Alogliptin, vildagliptin Pioglitazone Thiazolidinediones Glinides Nateglinide, Repaglinide Inhibitors Acarbose, Miglitol α-Glucosidase Incretins Exenatide, Liraglutide Amylin agonist Pramlintide Bile Acid Sequestrant Colesevalem Dopamine Agonist Bromocriptine Canagliflozin sodium-glucose cotransporter 2 (SGLT-2) Inhibitor Figure 1 : Glycemic management of type 2 diabetes. Agents that can be combined with metformin include insulin secretagogues, thiazolidinediones, inhibitors, DPP-IV inhibitors, and GLP-1 α-glucosidase receptor agonists. Treatment of complications 1-Retinopathy Early retinopathy may reverse with improved glycemic control. More • advanced disease may requires laser therapy (4). 2-Neuropathy (4).
1-In patients with type 2 diabetes, first-line therapy involves advice about dietary and lifestyle modification. Oral anti-diabetic drugs are usually added in those who do not achieve glycaemic targets as a result, or who have severe symptomatic hyperglycaemia at diagnosis and a high HbA1c (8). 2-However, the guidelines in some countries are to introduce medication immediately upon diagnosis of diabetes (8). 4 lists classes of drugs for type 2 DM (6). 3-A reasonable treatment algorithm for initial therapy uses metformin as initial therapy because of its efficacy, known side-effect profile, and relatively low cost (Fig. 1). Metformin has the advantage that it promotes mild weight loss, and improves the lipid profile slightly (9). However, type 2 DM is a progressive disorder and ultimately requires multiple therapeutic agents and often insulin (9). Table 4 :classes of drugs for type 2 DM Drug Type Examples Biguanides Metformin Sulfonylureas Glipizide , Glimepiride Glibenclamide Dipeptidyl peptidase IV (DPP-IV) inhibitors Sitagliptin , Saxagliptin, Linagliptin, Alogliptin, vildagliptin Thiazolidinediones Pioglitazone Glinides Nateglinide, Repaglinide α-Glucosidase Inhibitors Acarbose, Miglitol Incretins Exenatide, Liraglutide Amylin agonist Pramlintide Bile Acid Sequestrant Colesevalem Dopamine Agonist Bromocriptine sodium-glucose cotransporter 2 (SGLT-2) Inhibitor Canagliflozin Figure 1 : Glycemic management of type 2 diabetes. Agents that can be combined with metformin include insulin secretagogues, thiazolidinediones, α-glucosidase inhibitors, DPP-IV inhibitors, and GLP-1 receptor agonists. Treatment of complications 1-Retinopathy • Early retinopathy may reverse with improved glycemic control. More advanced disease may requires laser therapy (4). 2-Neuropathy (4).