Faculty of Medicine, Ben-Gurion University, Beer Sheva 8443944, Israel.
Faculty of Medicine, Tel Aviv University, Tel Aviv 69978, Israel.
Int J Mol Sci. 2023 Dec 5;24(24):17147. doi: 10.3390/ijms242417147.
The treatment of type 2 diabetes (T2D) necessitates a multifaceted approach that combines behavioral and pharmacological interventions to mitigate complications and sustain a high quality of life. Treatment encompasses the management of glucose levels, weight, cardiovascular risk factors, comorbidities, and associated complications through medication and lifestyle adjustments. Metformin, a standard in diabetes management, continues to serve as the primary, first-line oral treatment across all age groups due to its efficacy, versatility in combination therapy, and cost-effectiveness. Glucagon-like peptide-1 receptor agonists (GLP-1 RA) offer notable benefits for HbA1c and weight reduction, with significant cardiovascular benefits. Sodium-glucose cotransporter inhibitors (SGLT-2i) lower glucose levels independently of insulin while conferring notable benefits for cardiovascular, renal, and heart-failure outcomes. Combined therapies emphasizing early and sustained glycemic control are promising options for diabetes management. As insulin therapy remains pivotal, metformin and non-insulin agents such as GLP-1 RA and SGLT-2i offer compelling options. Notably, exciting novel treatments like the dual GLP-1/ glucose-dependent insulinotropic polypeptide (GIP) agonist show promise for substantially reducing glycated hemoglobin and body weight. This comprehensive review highlights the evolving landscape of pharmacotherapy in diabetes, the drugs currently available for treating diabetes, their effectiveness and efficacy, the impact on target organs, and side effects. This work also provides insights that can support the customization of treatment strategies.
2 型糖尿病（T2D）的治疗需要采取多方面的方法，结合行为和药物干预，以减轻并发症并维持高质量的生活。治疗包括通过药物和生活方式调整来管理血糖水平、体重、心血管危险因素、合并症和相关并发症。二甲双胍作为糖尿病管理的标准药物，由于其疗效、在联合治疗中的多功能性和成本效益，继续作为所有年龄段的主要一线口服治疗药物。胰高血糖素样肽-1 受体激动剂（GLP-1 RA）在降低 HbA1c 和体重方面具有显著益处，并且具有显著的心血管益处。钠-葡萄糖共转运蛋白抑制剂（SGLT-2i）在不依赖胰岛素的情况下降低血糖水平，同时对心血管、肾脏和心力衰竭结局有显著益处。强调早期和持续血糖控制的联合治疗是糖尿病管理的有前途的选择。由于胰岛素治疗仍然至关重要，二甲双胍和非胰岛素药物，如 GLP-1 RA 和 SGLT-2i，提供了有吸引力的选择。值得注意的是，令人兴奋的新型治疗方法，如双重 GLP-1/葡萄糖依赖性胰岛素释放肽（GIP）激动剂，有望显著降低糖化血红蛋白和体重。本综述强调了糖尿病药物治疗的不断发展的领域，目前可用于治疗糖尿病的药物、它们的有效性和疗效、对靶器官的影响以及副作用。这项工作还提供了可以支持治疗策略定制的见解。
