医学
2型糖尿病
背景(考古学)
重症监护医学
2型糖尿病
疾病
药理学
药效学
糖尿病
生物信息学
药代动力学
内分泌学
内科学
生物
古生物学
作者
Abd A Tahrani,Anthony Barnett,Clifford J. Bailey
标识
DOI:10.1038/nrendo.2016.86
摘要
Several classes of glucose-lowering therapies are now available for treatment of type 2 diabetes mellitus. In this Review, the current knowledge relating to mechanisms of action, pharmacokinetics, pharmacodynamics and safety profiles is presented for members of each of these drug classes. Type 2 diabetes mellitus (T2DM) is a global epidemic that poses a major challenge to health-care systems. Improving metabolic control to approach normal glycaemia (where practical) greatly benefits long-term prognoses and justifies early, effective, sustained and safety-conscious intervention. Improvements in the understanding of the complex pathogenesis of T2DM have underpinned the development of glucose-lowering therapies with complementary mechanisms of action, which have expanded treatment options and facilitated individualized management strategies. Over the past decade, several new classes of glucose-lowering agents have been licensed, including glucagon-like peptide 1 receptor (GLP-1R) agonists, dipeptidyl peptidase 4 (DPP-4) inhibitors and sodium/glucose cotransporter 2 (SGLT2) inhibitors. These agents can be used individually or in combination with well-established treatments such as biguanides, sulfonylureas and thiazolidinediones. Although novel agents have potential advantages including low risk of hypoglycaemia and help with weight control, long-term safety has yet to be established. In this Review, we assess the pharmacokinetics, pharmacodynamics and safety profiles, including cardiovascular safety, of currently available therapies for management of hyperglycaemia in patients with T2DM within the context of disease pathogenesis and natural history. In addition, we briefly describe treatment algorithms for patients with T2DM and lessons from present therapies to inform the development of future therapies.
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