Current complex treatment for type 2 diabetes mellitus in overweight patients with comorbidities (literature review)

Abstract

Diabetes is one of the most important medical and social problems on a global scale. This is due to the widespread character of the disease, prevalent undiagnosed diabetes and multiple complications. Despite the progress in developing new hypoglycemics, only 12.5% of patients achieve a satisfactory glycemic control. Two of the most prevalent concurrent conditions in patients with type 2 diabetes (T2DM) are overweight and obesity which are also contributing factors to the development of diabetes and its progression. The role of chronic inflammation in the development of T2DM and obesity is subject of scientifc research. Inflammatory processes are closely connected with increased speed of atherosclerosis development, hypertension and vascular diseases. Triggers for these mechanisms can include harmful eating habits, sedentary lifestyle and other lifestyle factors. These are connected to diabetes risk factors through intracellular changes which include stress of the endoplasmic reticulum and activation of stress-induced enzymes such as tumor necrotizing factor-α, interleukin-1β and interleukin-6 as well as high sensitivity C-reactive protein. The discovery of adipose tissue inflammation phenomenon allowed for a detailed examination of the modulation of metabolic and immune processes, which are expressed exceedingly in visceral fat. New therapeutic agents for treatment of T2DM were developed in recent years. Current approaches to T2DM treatment include traditional hypoglycemics, the focus of which is β-cell insufciency and/or insulin resistance, however newer classes of drugs which influence other defects such as incretin insufciency and include other metabolic glucose pathways appear to have a signifcant advantage.