Medications for Hyperglycemia in Type 2 Diabetes and Review of Insulin Degludec and Dapagliflozin

Patients with type 2 diabetes mellitus (T2DM) are usually treated with pharmacologic agents in combination with lifestyle modifications. Recently 2 drugs one being the injectable ultra-long acting analog insulin, degludec and the other being oral sodium glucose cotransporter 2 (SGLT2) inhibitor, dapagliflozin have been introduced to supplement the previous antidiabetic agents. The objective of this review article is to discuss the current pharmacological agents available, their successes, demerits and limitations in the treatment of patients with T2DM. This article also reviews currently available knowledge about degludec and dapagliflozin. Informations have been gathered from related clinical studies, research works, articles and abstracts published in various journals. It is generally agreed that metformin, if not contraindicated and if tolerated, is the preferred and most cost-effective first line agent for the treatment of T2DM. Insulin analogs are also becoming mainstream therapy for T2DM. Insulin degludec administered once daily is found to be significantly less variable and more stable in maintaining euglycemia as compared to insulin glargine and has flexibility in dosing time. It also causes lower incidence of hypoglycemia in both type 1 and type 2 diabetic patients. SGLT2 inhibitors are the most advanced new oral antidiabetic agents that lower glycosylated hemoglobin by increasing glycosuria and lead to a moderate weight loss. Dapagliflozin represents a novel approach to the management of T2DM.