Choosing the Best Oral Diabetic Agents in T2 Diabetes Mellitus-Physicians Challenge

The therapeutic armamentarium of oral diabetic agents has expanded its horizon from sulfonylureas in 1995 the only drug available for treating type 2 diabetes mellitus at that time to eleven classes of oral diabetes agents at present ranging from biguanides, thiazolidinediones, dipeptidyl peptidase-4 (DPP-4) inhibitors, alpha glucosidase inhibitors and sodium-glucose cotransporter (SGLT2) inhibitors. Despite the availability of so many options glycemic control remains suboptimal posing a real challenge for the clinicians to choose the best amongst them in treating type 2 diabetes mellitus. Before choosing the drugs it is important to know the recommendations of glycemic goals in adults. A reasonable glycosylated hemoglobin (A1C) goal in adult is <7%. However all glycemic goals should be individualized and customized. Setting individual glycemic goals needs consideration of several factors like risk of hypoglycemia and other adverse effects of drugs, disease duration, age and life expectancy of patients and other individual patient considerations like patients attitude resources and support system. Till today our approach towards diabetes management is GLUCOCENTRIC. The key component being how to achieve glycemic control with minimal side effects. While choosing drugs the factors considered are its efficacy (A1c reduction), risk of hypoglycaemia, effect on weight and other adverse effects, cost, ease of administration and patient’s preference. A patient-centered approach is of paramount importance while choosing the pharmacological agents rather that establishing a universally accepted algorithm as this will definitely improve the compliance. The advantages and disadvantages of each class of agents help the practitioners to choose the best options.