From a Glycocentric Approach to Prevention of Multi-Organ Damage in Type 2 Diabetes
Abstract
Nowadays, we are seeing radically interesting and promising changes in the treatment of patients with type-2 diabetes mellitus (T2 D), which favorably modify the prognosis related to fundamentally neuro-nephro and cardiorenal outcomes. Since no more than two decades ago, the pharmacological armamentarium for the treatment of people with T2D has basically consisted of the use of biguanides, sulfonylureas, insulin sensitizers, and insulins. A great amount of information has been accumulated through the results of new molecules such as sodium/glucose co-transporter type-2 inhibitors (SGLT2i), based on robust data arising from the experience of numerous studies, both clinical and experimental, as well as the glucagon-like peptide 1 receptor agonists (GLP-1ra), that has clearly shown multisystem benefits that improve the function of target organs and delay the onset of complications that ultimately impact the quality of life and the neuro-nephro-cardiovascular outcomes. In this review chapter, we not only highlight the different strategies for glucose control through SGLT2i, GLP-1ra or insulin, including even some fixed combinations, but also some information on different studies with GIP/GLP1 biagonist tirzepatide and on GIP/GLP1/Glucagon triagonist retatrutide primarily focused on weight loss, even though today, they are neither FDA approved nor a part of routine treatment.
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