Oral Pharmacologic Treatment of Type 2 Diabetes

A special issue of Journal of Clinical Medicine (ISSN 2077-0383). This special issue belongs to the section "Endocrinology & Metabolism".

Deadline for manuscript submissions: 15 June 2024 | Viewed by 3195

Special Issue Editor

Unidad de Endocrinología y Nutrición, Fundación Hospital Alcorcón, 28922 Madrid, Spain
Interests: obesity; metabolic surgery; precision diabetology
Special Issues, Collections and Topics in MDPI journals

Special Issue Information

Dear Colleagues,

We cordially invite you to participate as an author in this Special Issue of JCM on “Oral Pharmacologic Treatment of Type 2 Diabetes”.

Currently, there are 12 classes of glucose-lowering drugs (GLD) marketed in the world, and this number is expected to keep growing in the coming years. In addition, several weight-loss medications have a favorable effect on glycemic control in patients with T2DM and obesity. Therefore, T2DM therapy in the XXI century will require expert knowledge of the advantages and disadvantages of each available drug and the possibility of a rational combination based on phenotype, pathophysiology, and pharmacogenomics—in other words, precision diabetology.

Intensive glycemic control reduces microvascular complications of T2DM. As a consequence, despite not showing a clear beneficial effect on cardiovascular (CV) morbidity, the glucocentric strategy was established several decades ago as the dominant therapeutic model in all guidelines for the treatment of this disease. Most of our patients, however, show an increase in visceral fat, and they clearly benefit from an adipocentric strategy that simultaneously achieves enough weight loss to optimize glycemic control without hypoglycemia, reduces CV risk, and improves other obesity comorbidities. In fact, in recent years, several GLDs with weight-loss properties from two therapeutic families, GLP-1 receptor agonists (GLP-1 RAs) and sodium-glucose co-transporter type 2 inhibitors (SGLT-2i), have shown a reduction in CV and renal morbidity and mortality in patients with T2DM. All types of SGLT-2i and one GLP-1RA (semaglutide) are available as oral drugs.

In summary, we are living in an exciting era in the pharmacological treatment of T2DM. We look forward to receiving your submissions to this Special Issue.

Dr. Juan José Gorgojo-Martínez
Guest Editor

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Keywords

  • type 2 diabetes
  • oral glucose-lowering drugs
  • weight-loss medications
  • SGLT-2 inhibitors
  • oral GLP-1 analogs
  • metformin

Published Papers (2 papers)

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Research

9 pages, 1522 KiB  
Article
Predictive Factors of Renal Function Decline in Patients with Type 2 Diabetes Treated with Canagliflozin in the Real-Wecan Study
by Juan J. Gorgojo-Martinez, Miguel Brito-Sanfiel, Teresa Antón-Bravo, Alba Galdón Sanz-Pastor, Jaime Wong-Cruz and Manuel A. Gargallo Fernández
J. Clin. Med. 2022, 11(19), 5622; https://doi.org/10.3390/jcm11195622 - 24 Sep 2022
Cited by 1 | Viewed by 1229
Abstract
The Real-WECAN study evaluated the real-life effectiveness and safety of canagliflozin 100 mg daily (initiated in SGLT-2 inhibitors naïve patients) and canagliflozin 300 mg daily (switching from canagliflozin 100 mg or other SGLT-2 inhibitors) in individuals with type 2 diabetes. The objectives of [...] Read more.
The Real-WECAN study evaluated the real-life effectiveness and safety of canagliflozin 100 mg daily (initiated in SGLT-2 inhibitors naïve patients) and canagliflozin 300 mg daily (switching from canagliflozin 100 mg or other SGLT-2 inhibitors) in individuals with type 2 diabetes. The objectives of this sub-analysis were to estimate the eGFR slope over the follow-up period and to identify predictive factors of eGFR decline in a multiple linear regression analysis. A total of 583 patients (279 on canagliflozin 100 mg and 304 on canagliflozin 300 mg) were included, with median follow-up at 13 months. The patients had a mean age of 60.4 years, HbA1c of 7.76%, BMI of 34.7 kg/m2, eGFR below 60 mL/min/1.73 m2 8.6%, and urine albumin-to-creatinine ratio (UACR) above 30 mg/g 22.8%. eGFR decreased by −1.9 mL/min/1.73 m2 (p < 0.0001) by the end of the study. The mean eGFR slope during the maintenance phase was −0.16 mL/min/1.73 m2 per year. There were no significant differences between both doses of canagliflozin in the eGFR reduction or in the eGFR slope. The best predictive multivariate model of eGFR decline after canagliflozin therapy included age, hypertension, combined hyperlipidemia, heart failure, eGFR and severely increased albuminuria. All these variables except hypertension were independently associated with the outcome. In conclusion, in this real-world study, individuals with older age, combined hyperlipidemia, heart failure, higher eGFR and UACR > 300 mg/g showed a greater decline in their eGFR after canagliflozin treatment. Full article
(This article belongs to the Special Issue Oral Pharmacologic Treatment of Type 2 Diabetes)
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13 pages, 1302 KiB  
Article
Potential Risk of Overtreatment in Patients with Type 2 Diabetes Aged 75 Years or Older: Data from a Population Database in Catalonia, Spain
by Manel Mata-Cases, Didac Mauricio, Jordi Real, Bogdan Vlacho, Laura Romera-Liebana, Núria Molist-Brunet, Marta Cedenilla and Josep Franch-Nadal
J. Clin. Med. 2022, 11(17), 5134; https://doi.org/10.3390/jcm11175134 - 31 Aug 2022
Cited by 2 | Viewed by 1584
Abstract
Aim: To assess the potential risk of overtreatment in patients with type 2 diabetes (T2DM) aged 75 years or older in primary care. Methods: Electronic health records retrieved from the SIDIAP database (Catalonia, Spain) in 2016. Variables: age, gender, body mass index, registered [...] Read more.
Aim: To assess the potential risk of overtreatment in patients with type 2 diabetes (T2DM) aged 75 years or older in primary care. Methods: Electronic health records retrieved from the SIDIAP database (Catalonia, Spain) in 2016. Variables: age, gender, body mass index, registered hypoglycemia, last HbA1c and glomerular filtration rates, and prescriptions for antidiabetic drugs. Potential overtreatment was defined as having HbA1c < 7% or HbA1c < 6.5% in older patients treated with insulin, sulfonylureas, or glinides. Results: From a total population of 138,374 T2DM patients aged 75 years or older, 123,515 had at least one HbA1c available. An HbA1c below 7.0% was present in 59.1% of patients, and below 6.5% in 37.7%. Overall, 23.0% of patients were treated with insulin, 17.8% with sulfonylureas, and 6.6% with glinides. Potential overtreatment (HbA1c < 7%) was suspected in 26.6% of patients treated with any high-risk drug, 47.8% with sulfonylureas, 43.5% with glinides, and 28.1% with insulin. Using the threshold of HbA1c < 6.5%, these figures were: 21.6%, 24.4%, 17.9%, and 12.3%, respectively. Conclusion: One in four older adults with T2DM treated with antidiabetic drugs associated with a high risk of hypoglycemia might be at risk of overtreatment. This risk is higher in those treated with sulfonylureas or glinides than with insulin. Full article
(This article belongs to the Special Issue Oral Pharmacologic Treatment of Type 2 Diabetes)
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