Current Management of Type 2 Diabetes Mellitus: What to Pay Attention to in Outpatient Settings

Objective of the Review: To discuss the problem of selecting antihyperglycemic drugs; to identify the trends in prescription of various groups of oral antihyperglycemic agents. Key Points. When type 2 diabetes mellitus (DM2) is diagnosed, a number of patients need prompt combined antihyperglycemic therapy because of a marked carbohydrate metabolism disorder. The prescription paradigm of initial therapy has shifted towards antihyperglycemic agents with established nephro- and cardioprotective effects (sodium-glucose linked transporter-2 inhibitors, glucagon-like peptide-1 receptor agonists). Drugs are recommended depending on presence or absence of a comorbid cardiovascular disease (CVD) and cardiovascular risk factors, and safety as regards hypoglycaemic events; therefore, very often selection of a therapeutic regimen can be challenging. Still, the first-line treatment for patients without CVD is metformin; however, a combined therapy is required in the majority of cases. Poor compliance, continued use of monotherapy, despite the need to boost the therapy, patient’s reluctance to take additional drugs can facilitate occurrence and progression of a lot of associated complications. In such cases, combined medications reducing the amount of tablets and improving compliance are useful. The most common combination of antihyperglycemic drugs is metformin and sulfonylureas. Still, care should be taken because of differences in pharmacokinetics and pharmacodynamics of the molecules in the latter group. High selectivity of some sulfonylureas can evidence their milder effect for glucose level reduction. Sulfonylureas are also cost-effective as compared to other antidiabetic medications. Conclusion. A wide choice of drugs allows a medical professional selecting an optimal antihyperglycemic regimen, taking into account individual characteristics of a patient. Prompt combined medications are a treatment of choice for the majority of patients with DM. Selection of antihyperglycemic drugs is affected by the cost as well. The most important thing is that the drugs are well-studied, efficient and safe. Keywords: type 2 diabetes mellitus, combined therapy, sulphonylurea, Glimepiride, metformin.

Systematic review with meta-analysis on the use of antihyperglycemic agents as a preventive factor for cognitive losses in diabetic patients

Background: Blood glucose variations are generally associated with predisposition to the development of dementia in diabetes patients. And there is a controversy in the literature about whether the use of antihyperglycemic agents can(not) promote protective effects on cognition. Design and setting: we used a systematic review with meta-analysis to evaluate whether the evidence in the literature points to a protective or harmful effect of antihyperglycemic agents on cognition. Methods: PubMed, Science Direct and Scielo databases were used to collect articles in English, published between 2005 and 2020. Articles of reflection/opinion, monographs/theses/dissertations, and animal research were excluded. The blinding of authors during the searches contributed to search independence. Of 1,329 articles selected, 30 were adequate, but only 3 of these provided quantitative data from 53 cognitive tests, which were used for meta-analysis (random effect model), performed using R. Results: Funnel plot shows no publication bias. Forest plot, on the other hand, shows that literature points to the use of antihyperglycemic agents by patients as preventive of cognitive losses (standard mean difference equal to -0.18 [95% confidence interval between -0.29 and -0.06]). Conclusion: Evidence of the preventive effect of cognitive losses through the use of antihyperglycemic agents such as metformin should be further investigated, in order to better clarify this therapeutic potential.