A Review of the Novel Antidiabetic Medications: Efficacy, Safety and Innovation

Abstract

Type 2 diabetes is a chronic health condition affecting hundreds of millions of people. Type 2 diabetes has traditionally been combated with a combination of lifestyle modification, insulin therapy and pharmacological agents, including sulfonylureas, biguanides, thiazolidinediones and alpha-glucosidase inhibitors. Type 2 diabetes is associated with an increased risk of cardiovascular disease and the development of diabetic kidney disease. Although sulfonylureas are low-cost drugs and widely prescribed, they have been shown in recent cardiovascular outcome trials to present a high risk of hypoglycemia, which in turn increases the risk of negative cardiovascular outcomes. Metformin, a biguanide that is the most commonly-prescribed antidiabetic agent worldwide, is contraindicated in patients with risk factors for lactic acidosis, including heart failure and chronic kidney disease. The last decade has seen significant advances in the development of novel antidiabetic agents shown to possess both reno- and cardioprotective qualities. This article aims to review the available literature and recent studies demonstrating the efficacy and safety of these agents individually, as well as exploring areas of future development in the field. The reporting of this review is based on the 2020 PRISMA statement. A literature search for all papers related to antidiabetic medication was conducted using reliable sources such PubMed and Google Scholar Databases, including a recent meta-analysis of renal and cardiovascular outcome trials. A critical analysis of clinical trials on type 2 diabetes and the two most severe comorbidities in cardiovascular and chronic kidney diseases may help cardiologists, urologists and diabetes specialists to adapt their therapeutic approaches to individual patients. Data related to antidiabetic effects of agents of natural origin accompanied by their Cardioprotective and renoprotective capacity testify benefits of these compounds as novel therapeutic agents.