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MANAGING DIABETES MELLITUS: A WAY FORWARD

Mudasir Maqbool, Aqsa Munir, Dr Bushra Iqbal Puri

Diabetes Mellitus (DM) is a group of metabolic diseases characterized by an elevated blood glucose level – resulting from defects in insulin secretion, in insulin action or both. Diabetes Mellitus is not a pathogenic entity but a group of etiologically different metabolic defects that share the phenotype of hyperglycemia. Several distinct types of DM exist and are caused by complex interaction of genetic factors and life style choices. The metabolic dysregulation associated with DM causes secondary pathophysiologic changes in multiple organ systems that impose a tremendous burden on the individual with diabetes and on the health care system. Intensive diabetes management has set the goal of improvement of glycemic control, which reduces complications associated with the diseases. A strict control of blood glucose levels (Ideally HbA1c< 7% mean plasma glucose level, < 150 mg/dl) delays the onset and progression of diabetic neuropathy, nephropathy, retinopathy, and reduction in cardiovascular risk . Sulfonylureas (Glebenclemide, Gliclazide, Glemiperide, and tolbutamide), Biguandies (Metformin, Phenformin) are effectively used in controlling elevated blood glucose levels in oral antidiabetic therapy. . Sitagliptin is a once-daily, orally active, potent and highly selective dipeptidyl peptidase-4 (DPP-4) inhibitor approved in many countries for the treatment of patients with type- 2 diabetes. Sitagliptin was the first DPP-4 inhibitor that was approved for the management of type 2 diabetes in 2007. Sitagliptin is being used as monotherapy (100 or 200 mg OD) or as an add-on to ongoing oral antidiabetic agents (OAD) in patients with type 2 diabetes with significant reduction in glycaemic levels within a few weeks. In this review, we will briefly study the different therapeutic options available for the management of Diabetes Mellitus. Key words: Diabetes mellitus, Insulin, Sulfonylureas, Biguanides, Sitagliptin.

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