T2dm treatment
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Advances in Type 2 Diabetes Mellitus (T2DM) Treatment
Introduction to T2DM Treatment Options
Type 2 diabetes mellitus (T2DM) is a chronic condition characterized by insulin resistance and impaired insulin secretion. Managing T2DM effectively requires a multifaceted approach, including lifestyle modifications, pharmacological interventions, and, in some cases, surgical procedures. Recent research has provided new insights into various treatment options, ranging from novel drug therapies to innovative biological treatments.
Oral Semaglutide: A Promising GLP1 Receptor Agonist
Efficacy and Safety in Renal Impairment
The PIONEER trials have highlighted the efficacy and safety of oral semaglutide, a glucagon-like peptide 1 (GLP1) receptor agonist, in treating T2DM. In the PIONEER 5 study, oral semaglutide significantly reduced HbA1c levels in patients with moderate renal impairment, demonstrating its potential as a safe and effective treatment option for this subgroup1.
Cardiovascular Safety
The PIONEER 6 study further established the cardiovascular safety of oral semaglutide. Over a median follow-up of 15.9 months, the incidence of major cardiovascular events was comparable between the semaglutide and placebo groups, indicating that oral semaglutide does not increase cardiovascular risk1.
Comparison with Sitagliptin
In the PIONEER 7 study, oral semaglutide was compared with sitagliptin, a dipeptidyl peptidase 4 inhibitor. Patients receiving oral semaglutide achieved better glycemic control and weight loss, with a safety profile similar to injectable GLP1 receptor agonists1.
Dulaglutide and Cardiovascular Outcomes
The REWIND trial assessed the cardiovascular efficacy of dulaglutide, another GLP1 receptor agonist. The study found that dulaglutide reduced the incidence of major cardiovascular events in patients with and without previous cardiovascular disease, suggesting its utility in reducing cardiovascular risk in T2DM patients1.
Dapagliflozin: Protecting Kidney Function
The DECLARE–TIMI 58 trial evaluated dapagliflozin, a sodium-glucose cotransporter 2 (SGLT2) inhibitor, and its effects on kidney disease in T2DM patients. The study concluded that dapagliflozin slows the decline in eGFR and reduces the risk of end-stage renal disease or renal-associated death, making it a valuable option for protecting kidney function in T2DM patients1.
Substance-P: A Novel Immunomodulatory Approach
Substance-P (SP), a neuropeptide, has shown promise in reducing systemic inflammation and improving metabolic parameters in T2DM. In a study using Otsuka Long-Evans Tokushima Fatty rats, SP treatment inhibited weight gain, reduced lipid levels, and ameliorated hyperglycemia and insulin resistance. Additionally, SP restored retinal structure, suggesting its potential in preventing diabetic retinopathy2.
Metformin Combination Therapies in Youth
The TODAY study explored the efficacy of metformin alone versus in combination with rosiglitazone or lifestyle interventions in adolescents with T2DM. The study aims to determine the best approach for prolonging glycemic control and improving associated risk factors in this population, providing critical insights into early aggressive treatment strategies3.
Wharton’s Jelly Mesenchymal Stem Cell Transplantation
A phase I/II study investigated the efficacy and safety of Wharton’s Jelly-derived mesenchymal stem cell (WJ-MSC) transplantation in T2DM patients. The results indicated significant improvements in glucose control, beta cell function, and reductions in systemic inflammation, highlighting the potential of WJ-MSCs as a therapeutic option for T2DM4.
Natural Therapeutic Products
Natural health substances, including polyphenols and flavonoids, have been identified as potential adjuncts to pharmacological therapy in T2DM. These natural products may help prevent and ameliorate T2DM-related complications, offering a safer alternative or complement to traditional drug therapies5.
Pathophysiologic Approach to T2DM Therapy
A pathophysiologic approach to T2DM treatment involves using combination therapies that target specific pathophysiologic defects in T2DM. This individualized approach, endorsed by the American Diabetes Association, aims to correct insulin resistance and beta-cell failure, providing a more effective treatment strategy6.
Conclusion
The landscape of T2DM treatment is rapidly evolving, with new drug therapies, biological treatments, and combination strategies showing promise in improving patient outcomes. From oral semaglutide and dulaglutide to innovative approaches like SP and WJ-MSC transplantation, these advancements offer hope for better management of T2DM and its complications.
Sources and full results
Most relevant research papers on this topic
T2DM treatment trial results
Oral semaglutide is safe and effective for treating type 2 diabetes, with similar safety and effectiveness to injectable GLP1 receptor agonists.
RCT
Large Human TrialSP prevents T2DM complications by immunomodulation
Substance-p (SP) treatment can inhibit the progression of type 2 diabetes and diabetic retinopathy by suppressing inflammation and restoring damaged retinas.
Non-RCT
Animal Study
Rigorous JournalTreatment options for type 2 diabetes in adolescents and youth: a study of the comparative efficacy of metformin alone or in combination with rosiglitazone or lifestyle intervention in adolescents with type 2 diabetes
Early aggressive treatment with metformin and rosiglitazone or metformin and an intensive lifestyle intervention may prolong glycemic control and improve associated abnormalities and risk factors in adolescents with type 2 diabetes.
RCTLarge Human Trial
Highly CitedA preliminary evaluation of efficacy and safety of Wharton’s jelly mesenchymal stem cell transplantation in patients with type 2 diabetes mellitus
Wharton's jelly mesenchymal stem cell transplantation improves metabolic control and beta cell function in patients with type 2 diabetes mellitus, potentially through reduced systemic inflammation and immunological regulation.
RCTRigorous JournalHighly CitedPharmaceutical Drugs and Natural Therapeutic Products for the Treatment of Type 2 Diabetes Mellitus
Natural therapeutic products, such as flavonoids and polyphenols, may be a safer alternative to pharmaceutical drugs for treating type 2 diabetes, with combination therapies potentially being more efficient.
Highly CitedPathophysiologic Approach to Therapy in Patients With Newly Diagnosed Type 2 Diabetes
Selecting antidiabetes agents that correct specific pathophysiologic disturbances in type 2 diabetes patients is crucial for effective treatment and prevention of HbA1c rise.
Very Rigorous JournalHighly CitedExosomes derived from bone marrow mesenchymal stem cells harvested from type two diabetes rats promotes neurorestorative effects after stroke in type two diabetes rats
T2DM-MSC-Exo treatment significantly improves neurological function and attenuates post-stroke weight loss in type 2 diabetic rats, potentially benefiting stroke recovery.
RCTAnimal StudyRestoration of insulin receptor improves diabetic phenotype in T2DM mice.
Restoring insulin receptor expression using adeno-associated virus vectors is a safe and effective treatment for type 2 diabetes mellitus, improving diabetic phenotype in mice.
Non-RCTAnimal StudyRigorous JournalFGF1 — a new weapon to control type 2 diabetes mellitus
FGF1 injections show potential as a safe and effective treatment for type 2 diabetes mellitus, restoring euglycaemia without causing adverse effects.
Highly Cited