Key considerations in pharmacotherapy for type 2 diabetes mellitus: a multiple target organ approach

What is known and Objective: Type 2 diabetes mellitus (T2DM) is a progressive multisystem disease, and less than half the population with T2DM has achieved the recommended glycosylated haemoglobin A1c goal. We aim to present key points to consider when selecting pharmacotherapy for the management of T2DM. The selection of pharmacotherapy is discussed within the context of the underlying pathophysiology of T2DM, currently available treatment options highlighting newer agents and current clinical guidelines. Comment: Combination therapy regimens that target the multiple organ systems involved in the pathophysiology of T2DM can be developed based on the mechanism of action (MOA) of each class of agents. We compare the pathophysiology of T2DM with the MOA of the currently available non-insulin therapeutic options. What is new and Conclusion: Combination therapy that efficiently and effectively targets multiorgan correction with the least risk for serious adverse events, such as hypoglycaemia and drug interactions, is needed when initial treatment fails to achieve the desired clinical outcomes. Newer agents, now incorporated in treatment guidelines, increase the range of options available to the clinician.