title: Challenges Related to Glycemic Control in Type 2 Diabetes Mellitus Patients.
abstract: Diabetes mellitus (DM) is a chronic disease with long-term complications. Glycemic control is an important part in management of DM. The first line in treatment of type 2 DM (T2DM) is diet and life style change. Metformin is the first choice of medication in T2DM patients. Sulfonylureas have high risk of hypoglycemia. Glinides are associated with lower risk of hypoglycemia in comparison to sulfonylureas. Also, α-glucosidase inhibitors decrease the polysaccharides' digestion in small intestine and are less effective in comparison to metformin and sulfonylureas in lowering hemoglobin A1c (HbA1c). These have no risk for hypoglycemia, but gastrointestinal symptoms are common. Thiazolidinediones are known as insulin sensitizers and are effective for a longer duration in comparison to sulfonylureas, however, have side effects such as fluid retention, edema and heart failure. Incretin mimetics including exenatide and liraglutide act through increase in insulin secretion by pancreatic beta cells, in a glucose-dependent manner. Therefore, these are associated with no risk of hypoglycemia. Pramlintide is an amylin agonist which is also effective in lowering postprandial blood glucose. Sitagliptin and vildagliptin are dipeptidyl peptidase-4 inhibitors and have no risk of hypoglycemia when used as monotherapy. Canagliflozin and dapagliflozin decrease blood glucose level by increasing urinary glucose excretion and are associated with weight loss.
authors.affiliation: Infectious and Tropical Diseases Research Center, Hormozgan Health Institute, Hormozgan University of Medical Sciences, Bandar Abbas. Iran.
authors.forename: Masoumeh
authors.initials: M
authors.lastname: Kheirandish
authors.affiliation: Infectious and Tropical Diseases Research Center, Hormozgan Health Institute, Hormozgan University of Medical Sciences, Bandarabbas. Iran.
authors.forename: Hamidreza
authors.initials: H
authors.lastname: Mahboobi
authors.affiliation: Infectious and Tropical Diseases Research Center, Hormozgan Health Institute, Hormozgan University of Medical Sciences, Bandar Abbas. Iran.
authors.forename: Maryam
authors.initials: M
authors.lastname: Yazdanparast
authors.affiliation: King Fahd Medical Research Center, King Abdulaziz University, P.O. Box 80216, Jeddah 21589. Saudi Arabia.
authors.forename: Mohammad Amjad
authors.initials: MA
authors.lastname: Kamal
mesh_terms: D001786:Blood Glucose; D003924:Diabetes Mellitus, Type 2 / Q000097:blood / Q000178:diet therapy / Q000188:drug therapy / Q000628:therapy*; D005081:Exercise Therapy; D006801:Humans; D007004:Hypoglycemic Agents / Q000627:therapeutic use
chemical_list: D001786:Blood Glucose; D007004:Hypoglycemic Agents
keywords: Type 2 Diabetes Mellitus (T2DM); glycemic control; insulin; metformin; sulfonylureas; thiazolidinediones