[Treatment of type 2 diabetes mellitus].

Abstract

Modern diabetology is undergoing a paradigm shift from glucose-centric management toward risk-adapted precision medicine. Differentiated phenotyping into clusters allows for the early identification of organ-specific risks. Pharmacotherapy now prioritizes cardiorenal protection using sodium-glucose cotransporter 2 (SGLT2) inhibitors, glucagon-like peptide‑1 (GLP-1) receptor agonists, and nonsteroidal mineralocorticoid receptor antagonists (nsMRAs; finerenone), which reduce vascular events beyond glycated hemoglobin (HbA1c) reduction alone. Technological innovations, such as continuous glucose monitoring (CGM), complement traditional markers with dynamic metrics such as time in range. A new, realistic therapeutic goal is metabolic remission, facilitated by potent incretin mimetics and early intervention during the prediabetes stage. The ultimate objective is the sustainable restoration of normoglycemia and the prevention of end-organ damage through a multifactorial, individualized approach.