مقاله انگلیسی رایگان در مورد داروهای درمانی دیابت نوع 2 – الزویر 2017

Type 2 diabetes (T2DM) is a leading cause of morbidity and mortality worldwide and its prevalence is rising, rendering prevention and treatment of paramount importance. By 2040, the total number of diabetics worldwide is projected to increase to $642 million resulting in an increased economic burden [1]. In 2012, the total cost related to T2DM in United States of America (USA) was $245 billion with direct health care costs of $176 billion and reduced productivity of $69 billion [2]. After adjusting for population age and sex differences, average medical expenditures in individuals with T2DM were 2.3 times higher than those without diabetes, highlighting the need for more cost-effective strategies to prevent and treat diabetes [2]. T2DM is primarily characterized by insulin resistance (IR) and a defect in insulin secretion, the latter regarded as an early abnormality. The interplay between defective insulin secretion and IR initially leads to hyperglycemia, due to increased hepatic glucose production and decreased peripheral uptake of glucose. At a later stage, persistent hyperglycemia causes glucotoxity, increased oxidative stress and lipotoxicity, which causes further [3] reduction in insulin secretion due to progressive beta-cell failure [4]. Death risk in diabetes is about twice compared with non-diabetic individuals of similar age [5]. This proportion is even higher for women and younger individuals, although there is consideration about estimating mortality in T2DM [6]. The target for T2DM aims to reduce the risk of long-term complications and mortality [7–9]. Decrease in glycated hemoglobin A1C (HbA1c), an index for diabetes regulation and follow-up, lead to risk reduction for vascular complications and diabetes-related mortality (37% and 21%, respectively) [10]. Tight control of glycaemia (HbA1c <7%, as shown in UKPDS study) can reduce some of diabetic complications. On the other hand, glycemic targets should be more flexible in older individuals, particularly those with comorbidities, because hypoglycemia may result in higher mortality in these patients [11,12]. Therefore, an individualized approach is recommended by recent clinical guidelines [13,14]. The aim of this narrative review is to summarize the available pharmacologic treatment options for patients with T2DM. We also provide an individualized guide for initiation and intensification of treatment regimens and discuss the considerations and rationale for individualized HbA1c goal.