Pharmacotherapeutic options for the management of Type 2 Diabetes Mellitus: literature review

Authors

DOI:

https://doi.org/10.33448/rsd-v12i3.40605

Keywords:

Diabetes Mellitus, Type 2; Hypoglycemic agents; Drug therapy; Review.

Abstract

In parallel with population aging and contemporary lifestyle, the incidence of individuals living with Type 2 Diabetes Mellitus (T2DM) is increasing, making it one of the main causes of morbidity and mortality in the world. In order to make a more assertive and individualized therapeutic choice and avoid micro and macrovascular complications secondary to T2DM, it is essential that health professionals are aware of all available pharmacotherapeutic resources. This work is a narrative review with the objective of discussing the particularities of the therapeutic options currently available for the management of T2DM. Books, clinical protocols, therapeutic guidelines and academic articles available in Scielo and Google academic databases were searched, considering works written in Portuguese or English. The search was performed in October 2022. The results reinforce that the importance of glycemic control to reduce the risk of complications is widely recognized by current therapeutic protocols and favor the adoption of evidence-based clinical approaches. There are many therapeutic options with demonstrated efficacy in achieving therapeutic goals, the main pharmacological classes are: biguanides, glitazones, sulfonylureas, glinides, alpha-glucosidase inhibitors, insulins, DDP-4 inhibitors, GLP-1 agonists and SGLT2 inhibitors. Treatment options, however, need to be individualized according to clinical characteristics (risk of hypoglycemia, age, comorbidities, disease stage, T2DM complications, tolerability and adverse effects), sociodemographic characteristics, preferences and individual values, favoring the person-centered care.

Author Biographies

Cristian Bianchi Lissi, Universidade de São Paulo

Undergraduate nursing student. 

Maria Olívia Barboza Zanetti, Universidade de São Paulo

Pharmacist, Professor at the Department of Psychiatric Nursing and Human Sciences.

References

Barbin, I. C. C. (2018). Anatomia e fisiologia humana. Editora e Distribuidora Educacional S.A.

Bertoluci, M. C., Salles, J. E. N., Silva-Nunes, J., Pedrosa, H. C., Moreira, R. O., Da Silva Duarte, R. M. C., Da Costa Carvalho, D. M., Trujilho, F. R., Dos Santos Raposo, J. F. C., Parente, E. B., Valente, F., De Moura, F. F., Hohl, A., Melo, M., Araujo, F. G. P., De Araújo Principe, R. M. M. C., Kupfer, R., Costa E Forti, A., Valerio, C. M., … Leitão, C. B. (2020). Portuguese-Brazilian evidence-based guideline on the management of hyperglycemia in type 2 diabetes mellitus. Diabetology & Metabolic Syndrome, 12(45), 1-30. https://doi.org/10.1186/S13098-020-00551-1

Bezerra, T. G., Gonçalves, A. L. G., Franco, A. M., Rossi, B. A., Schiefler, G. A. G., Winter, M. L., Marques, M. O., Bark, S., Cruz, V. S., & Rêgo, R. C. L. (2021). Repercussões cardiovasculares do uso de inibidores de SGLT2 em portadores de Diabetes Mellitus tipo 2. Revista Eletrônica Acervo Saúde, 13(5), e6890–e6890. https://doi.org/10.25248/REAS.E6890.2021

Bombarda, F. P., Peroni, F. da M., & Veríssimo, L. C. G. (2018). Linha de cuidado diabetes mellitus: manual de orientação clínica (2 ed). SES/SP.

Brasil. (2020). Protocolo clínico e diretrizes terapêuticas do diabete melito tipo 2. Ministério da Saúde.

Brasil.. (2022a). Relação Nacional de Medicamentos Essenciais Rename 2022. Ministério da Saúde.

Brasil. (2022b). Portaria GM/MS no 3.677, de 29 de setembro de 2022. Altera a Portaria de Consolidação GM/MS no 5, de 28 de setembro de 2017, e amplia a cobertura do Programa Farmácia Popular do Brasil - PFPB. Diário Oficial da União.

Brunton, L. L. (2012). As Bases Farmacológicas da Terapêutica de Goodman & Gilman (12 ed.). AMGH.

Cai, X., Gao, X., Yang, W., Han, X., & Ji, L. (2018). Efficacy and Safety of Initial Combination Therapy in Treatment-Naïve Type 2 Diabetes Patients: A Systematic Review and Meta-analysis. Diabetes Ther., 9(5), 1995–2014. https://doi.org/10.1007/S13300-018-0493-2

Carvalho, D., Nunes, J. S., Raposo, J. F., Medina, J. L., Jácome De Castro, J., & Carrilho, F. (2016). Agonistas dos Receptores do GLP-1 no Tratamento da Diabetes Tipo 2 . Revista Portuguesa de Diabetes, 11(4), 154–166.

de Oliveira, R. E. M., Icuma, T. R., Ueta, J., & Franco, L. J. (2021). Uso e acesso aos medicamentos para o diabetes mellitus tipo 2 em idosos: um estudo de base populacional. Ciência & Saúde Coletiva, 26, 5081–5088. https://doi.org/10.1590/1413-812320212611.3.03752020

Duarte, R. (2017). Inibidores da DPP-4 (Gliptinas) - 10 anos depois (2007-2017). Revista Portuguesa de Diabetes, 12(2), 62–67.

Estrela, C. (2018). Metodologia Cientifica: Ciência, Ensino, Pesquisa. Editora Artes Médicas.

Freitas, A. M. M., Belido, B. M., da Silva, R. A. R., & Kury, C. M. H. (2021). Novos tratamentos para o Diabetes Mellitus tipo 2. Revista Científica Da Faculdade de Medicina de Campos, 16(2), 89–97. https://doi.org/10.29184/1980-7813.RCFMC.506.VOL.16.N2.2021

Fuchs, F. D., & Wannmacher, L. (2017). Farmacologia Clínica e Terapêutica (5a ed.). Guanabara Koogan.

Hall, J. E., & Hall, M. E. (2021). Tratado de Fisiologia Médica (14a ed.). Guanabara Koogan.

Instituto Brasileiro de Geografia e Estatística. (2020). Pesquisa Nacional de Saúde - 2019. IBGE. https://biblioteca.ibge.gov.br/visualizacao/livros/liv101764.pdf

International Diabetes Federation. (2021). IDF Diabetes Atlas 2021 (10a ed.). International Diabetes Federation. https://diabetesatlas.org/idfawp/resource-files/2021/07/IDF_Atlas_10th_Edition_2021.pdf

Kalyon, S., Özkan Gümüşkaya, P., Özsoy, N., Özcan, M., Selcen Pala, A., Basmakçı, A., Arman, Y., Tükek, T., & Makalesi, A. (2020). Delay in starting insulin therapy in patients with type 2 Diabetes diyabetes mellitus hastalarında insülin tedavisine geç başlama. J Surg Med, 4(8), 685–688. https://doi.org/10.28982/josam.776346

Khunti, K., Nikolajsen, A., Thorsted, B. L., Andersen, M., Davies, M. J., & Paul, S. K. (2016). Clinical inertia with regard to intensifying therapy in people with type 2 diabetes treated with basal insulin. Diabetes, Obesity and Metabolism, 18, 401–409. https://doi.org/10.1111/dom.12626

Lyra, R., Albuquerque, L., Cavalcanti, S., Tambascia, M., Valente, F., & Bertoluci, M. (2022). Tratamento farmacológico da hiperglicemia no DM2. Diretriz Oficial Da Sociedade Brasileira de Diabetes. https://doi.org/10.29327/557753.2022-10

Mahaffey, K. W., Neal, B., Perkovic, V., De Zeeuw, D., Fulcher, G., Erondu, N., Shaw, W., Fabbrini, E., Sun, T., Li, Q., Desai, M., & Matthews, D. R. (2018). Canagliflozin for Primary and Secondary Prevention of Cardiovascular Events: Results From the CANVAS Program (Canagliflozin Cardiovascular Assessment Study). Circulation, 137(4), 323–334. https://doi.org/10.1161/CIRCULATIONAHA.117.032038

Maia, F. F. R., Melo, F. J., Araújo, I. M., & Araújo, L. R. (2007). Substituição da insulina NPH por insulina glargina em uma coorte de pacientes diabéticos: estudo observacional. Arquivos Brasileiros de Endocrinologia & Metabologia, 51(3), 426–430. https://doi.org/10.1590/S0004-27302007000300010

Mata-Cases, M., Roura-Olmeda, P., Franch-Nadal, J., Pepió -Vilaubí, J. M., Saez, M., & Coll-De-Tuero, G. (2013). Clinical inertia in the treatment of hyperglycemia in type 2 diabetes patients in primary care . Current Medical Research & Opinion, 29(11). https://doi.org/10.1185/03007995.2013.833089

Oliveira, R. G. de P. (2016). Blackbook Enfermagem. Blackbook.

Rocha, K. N. S., Pereira, B. M., Costa, I. L., Fabri, G. G., Wilhans, C. N., Lemos, L. F., Machado, M. R. R., & Rodrigues, M. S. D. L. (2022). Eficácia dos inibidores da dipeptidil peptidase 4 (DPP-4) para o tratamento da diabetes mellitus 2 . Brazilian Journal of Health Review, 5(1), 286–303. https://doi.org/10.34119/BJHRV5N1-026

Rodacki, M., Bezerra, M. G. T., Gabbay, M. A. L., Montenegro Junior, R. M., & Bertoluci, M. C. (2021). Classificação do diabetes. Diretriz Da Sociedade Brasileira de Diabetes. https://doi.org/10.29327/540652.1-1

Rodrigues, A. T., Garro, L. S., Tanno, L. K., Motta, A. A., & Ensina, L. F. (2009). Reações de hipersensibilidade à insulina Insulin hypersensitivity reactions. Rev. Bras. Alerg. Imunopatol. , 32(6), 217–2020.

Santos, P. C. J. de L. (2021). Livro-Texto Farmacologia. Atheneu.

Sperling, M. A., & Laffel, L. M. (2022). Current Management of Glycemia in Children with Type 1 Diabetes Mellitus. The New England Journal of Medicine, 386(12), 1155–1164. https://doi.org/10.1056/NEJMCP2112175

World Health Organization. (2020). Global Health Estimates: Life expectancy and leading causes of death and disability. https://www.who.int/data/gho/data/themes/mortality-and-global-health-estimates

World Health Organization. (2021). Diagnosis and management of type 2 diabetes (HEARTS-D). https://apps.who.int/iris/bitstream/handle/10665/331710/WHO-UCN-NCD-20.1-eng.pdf?sequence=1&isAllowed=y

Published

04/03/2023

How to Cite

LISSI, C. B. .; ZANETTI, M. O. B. . Pharmacotherapeutic options for the management of Type 2 Diabetes Mellitus: literature review. Research, Society and Development, [S. l.], v. 12, n. 3, p. e15112340605, 2023. DOI: 10.33448/rsd-v12i3.40605. Disponível em: https://rsdjournal.org/index.php/rsd/article/view/40605. Acesso em: 30 dec. 2024.

Issue

Section

Review Article