An updated review on anti-diabetic agents and their functions: a comparative study

Abrar Hussain, Abdul Latif, Zainia Rehmat, Musarat Riaz, Nelofer Jamil, Muhammad Amir, Muhammad Asif


Chronic metabolic disease is considered by a high concentration of glucose in the blood consequent from imperfections in insulin secretion or insulin action. Currently, it is rapidly becoming an epidemic in several nations around the world affecting millions of people. Hence, it is predicted that the number of affected may double in the next couple of years. This increase may be due to the rise in the aging population, adding to an already existing burden on healthcare providers, particularly in developing countries. Based on the unusual elevation of plasma glucose diabetes is divided into two main types, comprising type (1, 2) DM, gestational diabetes mellitus, neonatal diabetes, maturity-onset diabetes of the young (MODY), and squeals induced by endocrinopathies, the consumption of steroids, along with other elements. T1 diabetes mellitus and T2 diabetes mellitus are considered inadequate insulin synthesis. Type 1 diabetes is a condition that usually affects young people, while type 2 diabetes is more common in older individuals who have unhealthy lifestyles. Both types of diabetes have different causes, symptoms, and treatments due to their distinct differences in how the body processes sugar. The aim of the present study is to learn more specifically pertaining to diabetes mellitus, its complications including clinical appearance, associated risk factors, anti-diabetic regime and its consequences at present.

Full Text:



Wen J, Lin T, Cai Y, Chen Q, Chen Y, et al. Baduanjin exercise for type 2 diabetes mellitus: a systematic review and meta-analysis of randomized controlled trials. Evidence-Based Complementary and Alternative Medicine, (2017); 2017.

Raj RRR, Sahay SSS, Tripathi JTJ. Medications of diabetes mellitus and antidiabetic medicinal plants: a review. International Journal of Indigenous Herbs and Drugs, (2016); 19-28.

Ohiagu FO, Chikezie PC, Chikezie CM. Pathophysiology of diabetes mellitus complications: Metabolic events and control. Biomed Res Ther, (2021); 8(3): 4243-4257.

Chiefari E, Arcidiacono B, Foti D, Brunetti A. Gestational diabetes mellitus: an updated overview. Journal of endocrinological investigation, (2017); 40899-909.

Forbes JM, Cooper ME. Mechanisms of diabetic complications. Physiological reviews, (2013); 93(1): 137-188.

AMS DP, Mori Y, De Silva S. Self-Care among Adolescents with Type 1 Diabetes Mellitus and Nursing Care in Sri Lanka: Review of Literature. 北関東医学, (2016); 66(1): 15-22.

Abbood M, Al-Rawi KF. Purification and characterization of Alkaline phosphatase from patients women breast cancer.

Charan Kumar C, Murthy S. A review on management of blood glucose in type 2 diabetes mellitus. Int J Plant Sciences, (2016); 6114-120.

Qaseem A, Barry MJ, Humphrey LL, Forciea MA, Physicians* CGCotACo. Oral pharmacologic treatment of type 2 diabetes mellitus: a clinical practice guideline update from the American College of Physicians. Annals of internal medicine, (2017); 166(4): 279-290.

Balaji R, Duraisamy R, Kumar M. Complications of diabetes mellitus: A review. Drug Invention Today, (2019); 12(1).

Zhuang Q-S, Shen L, Ji H-F. Quantitative assessment of the bidirectional relationships between diabetes and depression. Oncotarget, (2017); 8(14): 23389.

Sortsoe C, Green A, Jensen PB, Emneus M. Societal costs of diabetes mellitus in Denmark. Diabetic Medicine, (2016); 33(7): 877-885.

Tracey ML, Gilmartin M, O’Neill K, Fitzgerald AP, McHugh SM, et al. Epidemiology of diabetes and complications among adults in the Republic of Ireland 1998-2015: a systematic review and meta-analysis. BMC public health, (2015); 16(1): 1-13.

Chen R, Ovbiagele B, Feng W. Diabetes and stroke: epidemiology, pathophysiology, pharmaceuticals and outcomes. The American journal of the medical sciences, (2016); 351(4): 380-386.

Gonzalez JS, Esbitt SA, Schneider HE, Osborne PJ, Kupperman EG. Psychological issues in adults with type 2 diabetes. Psychological co-morbidities of physical illness: A behavioral medicine perspective, (2011); 73-121.

Emdin CA, Rahimi K, Neal B, Callender T, Perkovic V, et al. Blood pressure lowering in type 2 diabetes: a systematic review and meta-analysis. Jama, (2015); 313(6): 603-615.

Tao Z, Shi A, Zhao J. Epidemiological perspectives of diabetes. Cell biochemistry and biophysics, (2015); 73181-185.

Thent ZC, Das S, Henry LJ. Role of exercise in the management of diabetes mellitus: the global scenario. PloS one, (2013); 8(11): e80436.

Feingold KR, Anawalt B, Boyce A, Chrousos G, Dungan K, et al. Oral and injectable (non-insulin) pharmacological agents for type 2 diabetes. Endotext South Dartmouth (MA), (2020).

Adisakwattana S. Cinnamic acid and its derivatives: mechanisms for prevention and management of diabetes and its complications. Nutrients, (2017); 9(2): 163.

Crews KR, Hicks JK, Pui CH, Relling MV, Evans WE. Pharmacogenomics and individualized medicine: translating science into practice. Clinical Pharmacology & Therapeutics, (2012); 92(4): 467-475.

Bansal R, Agarwal P. Prevalence of Diabetes and Hypertension among Adults 20 Yrs and above in Urban Slums of Delhi. Call for Editorial Board Members, 65.

Ismail-Beigi F, Craven T, Banerji MA, Basile J, Calles J, et al. Effect of intensive treatment of hyperglycaemia on microvascular outcomes in type 2 diabetes: an analysis of the ACCORD randomised trial. The Lancet, (2010); 376(9739): 419-430.

Phan DH, Do VV, Khuong LQ, Nguyen HT, Minh HV. Prevalence of diabetes and prediabetes among children aged 11-14 years old in Vietnam. Journal of Diabetes Research, (2020); 2020.

O'neill D, Gostelow R, Orme C, Church D, Niessen S, et al. Epidemiology of diabetes mellitus among 193,435 cats attending primary‐care veterinary practices in England. Journal of Veterinary Internal Medicine, (2016); 30(4): 964-972.

Deshpande AD, Harris-Hayes M, Schootman M. Epidemiology of diabetes and diabetes-related complications. Physical therapy, (2008); 88(11): 1254-1264.

Craig ME, Hattersley A, Donaghue KC. Definition, epidemiology and classification of diabetes in children and adolescents. Pediatr diabetes, (2009); 10(Suppl 12): 3-12.

Ma W-T, Chang C, Gershwin ME, Lian Z-X. Development of autoantibodies precedes clinical manifestations of autoimmune diseases: A comprehensive review. Journal of autoimmunity, (2017); 8395-112.

Patterson C, Guariguata L, Dahlquist G, Soltész G, Ogle G, et al. Diabetes in the young–a global view and worldwide estimates of numbers of children with type 1 diabetes. Diabetes research and clinical practice, (2014); 103(2): 161-175.

Zimmet PZ, Alberti KGM. Epidemiology of diabetes—status of a pandemic and issues around metabolic surgery. Diabetes care, (2016); 39(6): 878-883.

Basit A, Fawwad A, Qureshi H, Shera A. Prevalence of diabetes, pre-diabetes and associated risk factors: second National Diabetes Survey of Pakistan (NDSP), 2016–2017. BMJ open, (2018); 8(8): e020961.

Morran MP, Vonberg A, Khadra A, Pietropaolo M. Immunogenetics of type 1 diabetes mellitus. Molecular aspects of medicine, (2015); 4242-60.

Cruz NG, Sousa LP, Sousa MO, Pietrani NT, Fernandes AP, et al. The linkage between inflammation and Type 2 diabetes mellitus. Diabetes research and clinical practice, (2013); 99(2): 85-92.

Kumar Arora M, Kumar Singh U. Oxidative stress: meeting multiple targets in pathogenesis of diabetic nephropathy. Current drug targets, (2014); 15(5): 531-538.

Evans JL, Goldfine ID, Maddux BA, Grodsky GM. Are oxidative stress− activated signaling pathways mediators of insulin resistance and β-cell dysfunction? Diabetes, (2003); 52(1): 1-8.

Juszczyk A, Jankowska K, Zawiślak B, Surdacki A, Chyrchel B. Depressed cardiac mechanical energetic efficiency: a contributor to cardiovascular risk in common metabolic diseases—from mechanisms to clinical applications. Journal of clinical medicine, (2020); 9(9): 2681.

Hameed I, Masoodi SR, Mir SA, Nabi M, Ghazanfar K, et al. Type 2 diabetes mellitus: from a metabolic disorder to an inflammatory condition. World journal of diabetes, (2015); 6(4): 598.

Rains JL, Jain SK. Oxidative stress, insulin signaling, and diabetes. Free radical biology and medicine, (2011); 50(5): 567-575.

Niki E. Lipid peroxidation products as oxidative stress biomarkers. Biofactors, (2008); 34(2): 171-180.

Shabalala SC, Johnson R, Basson AK, Ziqubu K, Hlengwa N, et al. Detrimental Effects of Lipid Peroxidation in Type 2 Diabetes: Exploring the Neutralizing Influence of Antioxidants. Antioxidants, (2022); 11(10): 2071.

Mazur-Bialy A, Kozlowska K, Pochec E, Bilski J, Brzozowski T. Myokine irisin-induced protection against oxidative stress in vitro. Involvement of heme oxygenase-1 and antioxidazing enzymes superoxide dismutase-2 and glutathione peroxidase. J Physiol Pharmacol, (2018); 69(1): 117-125.

Gerber PA, Rutter GA. The role of oxidative stress and hypoxia in pancreatic beta-cell dysfunction in diabetes mellitus. Antioxidants & redox signaling, (2017); 26(10): 501-518.

Kochikuzhyil BM (2009) Evaluation of Dyslipidemic Effect Of Dietary Vegetable Oils Under Stress And Non-Stress Conditions In Normal And Diabetic Rats: Rajiv Gandhi University of Health Sciences (India).

Agrawal NK, Kant S. Targeting inflammation in diabetes: Newer therapeutic options. World journal of diabetes, (2014); 5(5): 697.

Alipourfard I, Datukishvili N, Mikeladze D. TNF-α downregulation modifies insulin receptor substrate 1 (IRS-1) in metabolic signaling of diabetic insulin-resistant hepatocytes. Mediators of inflammation, (2019); 2019.

Vaxillaire M, Froguel P. Best Practice & Research Clinical Endocrinology & Metabolism. Best Practice & Research Clinical Endocrinology & Metabolism, (2012); 26171-187.

Lavin DP, White MF, Brazil DP. IRS proteins and diabetic complications. Diabetologia, (2016); 59(11): 2280-2291.

Arikoglu H, Hepdogru MA, Kaya DE, Asik A, Ipekci SH, et al. IRS1 gene polymorphisms Gly972Arg and Ala513Pro are not associated with insulin resistance and type 2 diabetes risk in non-obese Turkish population. Meta gene, (2014); 2579-585.

Sanchez-Rangel E, Inzucchi SE. Metformin: clinical use in type 2 diabetes. Diabetologia, (2017); 601586-1593.

Herman R, Kravos NA, Jensterle M, Janež A, Dolžan V. Metformin and insulin resistance: a review of the underlying mechanisms

behind changes in GLUT4-mediated glucose transport. International Journal of Molecular Sciences, (2022); 23(3): 1264.

Rena G, Hardie DG, Pearson ER. The mechanisms of action of metformin. Diabetologia, (2017); 60(9): 1577-1585.

Kinaan M, Ding H, Triggle CR. Metformin: an old drug for the treatment of diabetes but a new drug for the protection of the endothelium. Medical principles and practice, (2015); 24(5): 401-415.

Freeland B, Farber MS. Type 2 diabetes drugs: a review. Home healthcare now, (2015); 33(6): 304-310.

de Souza GS, Mantovani DB, Mossel P, Haarman BC, da Silva AMM, et al. Oral administration of PET tracers: Current status. Journal of Controlled Release, (2023); 357591-605.

Osadebe PO, Odoh EU, Uzor PF. Oral anti-diabetic agents-review and updates. Management, (2015); 21.

Kupsal K, Mudigonda S, Sai N, Neelala K, Hanumanth S. Metformin combinatorial therapy for type 2 diabetes mellitus. J Metab Syndr, (2016); 5(3): 1000210.

Gautam D, Gautam D. A Short Review On Anti-Diabetic Agent. PharmaTutor, (2014); 2(10): 89-105.

Popovic-Djordjevic JB, Jevtic II, Stanojkovic TP. Antidiabetics: structural diversity of molecules with a common aim. Current Medicinal Chemistry, (2018); 25(18): 2140-2165.

Hemmingsen B, Schroll JB, Wetterslev J, Gluud C, Vaag A, et al. Sulfonylurea versus metformin monotherapy in patients with type 2 diabetes: a Cochrane systematic review and meta-analysis of randomized clinical trials and trial sequential analysis. Canadian Medical Association Open Access Journal, (2014); 2(3): E162-E175.

White Jr JR. A brief history of the development of diabetes medications. Diabetes spectrum: a publication of the American Diabetes Association, (2014); 27(2): 82.

CHAUHAN M, VARMA AK. Indian Journal of Novel Drug Delivery. Indian Journal of Novel Drug Delivery, (2022); 14(1): 8-15.

Hirst J, Farmer A, Dyar A, Lung T, Stevens R. Estimating the effect of sulfonylurea on HbA 1c in diabetes: a systematic review and meta-analysis. Diabetologia, (2013); 56973-984.

Chaudhury A, Duvoor C, Reddy Dendi VS, Kraleti S, Chada A, et al. Clinical review of antidiabetic drugs: implications for type 2 diabetes mellitus management. Frontiers in endocrinology, (2017); 86.

Deacon C, Lebovitz HE. Comparative review of dipeptidyl peptidase‐4 inhibitors and sulphonylureas. Diabetes, Obesity and Metabolism, (2016); 18(4): 333-347.

Yang M, Dart C, Kamishima T, Quayle JM. Hypoxia and metabolic inhibitors alter the intracellular ATP: ADP ratio and membrane potential in human coronary artery smooth muscle cells. PeerJ, (2020); 8e10344.

So WY, Liu WN, Teo AKK, Rutter GA, Han W. Paired box 6 programs essential exocytotic genes in the regulation of glucose-stimulated insulin secretion and glucose homeostasis. Science Translational Medicine, (2021); 13(600): eabb1038.

Gunton JE, Cheung NW, Davis TME, Zoungas S, Colagiuri S. A new blood glucose management algorithm for type 2 diabetes: a position statement of the Australian Diabetes Society. Medical journal of Australia, (2014); 201(11): 650-653.

Forst T, Hanefeld M, Jacob S, Moeser G, Schwenk G, et al. Association of sulphonylurea treatment with all-cause and cardiovascular mortality: a systematic review and meta-analysis of observational studies. Diabetes and Vascular Disease Research, (2013); 10(4): 302-314.

Chen Y, Du L, Li L, Ma J, Geng X, et al. Cancer risk of sulfonylureas in patients with type 2 diabetes mellitus: A systematic review. Journal of Diabetes, (2017); 9(5): 482-494.

Farahani P, Khan S, Oatway M, Dziarmaga A. Exploring the distribution of prescription for sulfonylureas in patients with type 2 diabetes according to cardiovascular risk factors within a Canadian primary care setting. Journal of Population Therapeutics and Clinical Pharmacology, (2015); 22(3).

Wu P-C, Wu V-C, Lin C-J, Pan C-F, Chen C-Y, et al. Meglitinides increase the risk of hypoglycemia in diabetic patients with advanced chronic kidney disease: a nationwide, population-based study. Oncotarget, (2017); 8(44): 78086.

Guardado-Mendoza R, Prioletta A, Jiménez-Ceja LM, Sosale A, Folli F. State of the art paper The role of nateglinide and repaglinide, derivatives of meglitinide, in the treatment of type 2 diabetes mellitus. Archives of medical science, (2013); 9(5): 936-943.

Brunetti L, Kalabalik J. Management of type-2 diabetes mellitus in adults: focus on individualizing non-insulin therapies. Pharmacy and therapeutics, (2012); 37(12): 687.

Rizos CV, Elisaf M, Mikhailidis DP, Liberopoulos EN. How safe is the use of thiazolidinediones in clinical practice? Expert opinion on drug safety, (2009); 8(1): 15-32.

Rathwa N, Patel R, Palit SP, Parmar N, Rana S, et al. β-cell replenishment: Possible curative approaches for diabetes mellitus. Nutrition, Metabolism and Cardiovascular Diseases, (2020); 30(11): 1870-1881.

Della-Morte D, Palmirotta R, Rehni AK, Pastore D, Capuani B, et al. Pharmacogenomics and pharmacogenetics of thiazolidinediones: role in diabetes and cardiovascular risk factors. Pharmacogenomics, (2014); 15(16): 2063-2082.

Goltsman I, Khoury EE, Winaver J, Abassi Z. Does Thiazolidinedione therapy exacerbate fluid retention in congestive heart failure? Pharmacology & Therapeutics, (2016); 16875-97.

Lu P, Zhao Z. Advances on PPARγ research in the emerging era of precision medicine. Current drug targets, (2018); 19(6): 663-673.

Kalra S. Alpha glucosidase inhibitors. JPMA The Journal of the Pakistan Medical Association, (2014); 64(4): 474-476.

Hedrington MS, Davis SN. Considerations when using alpha-glucosidase inhibitors in the treatment of type 2 diabetes. Expert opinion on pharmacotherapy, (2019); 20(18): 2229-2235.

Kashtoh H, Baek K-H. Recent Updates on Phytoconstituent Alpha-Glucosidase Inhibitors: An Approach towards the Treatment of Type Two Diabetes. Plants, (2022); 11(20): 2722.

Suzuki K, Katsura D, Sagara M, Aoki C, Nishida M, et al. Postprandial reactive hypoglycemia treated with a low-dose alpha-glucosidase Inhibitor: Voglibose may suppress oxidative stress and prevent endothelial dysfunction. Internal Medicine, (2016); 55(8): 949-953.

Peters A. Incretin-based therapies: review of current clinical trial data. The American journal of medicine, (2010); 123(3): S28-S37.

Garber AJ. Incretin-based therapies in the management of type 2 diabetes: rationale and reality in a managed care setting. American Journal of Managed Care, (2010); 16(7): S187.

Ceriello A, Sportiello L, Rafaniello C, Rossi F. DPP-4 inhibitors: pharmacological differences and their clinical implications. Expert opinion on drug safety, (2014); 13(sup1): 57-68.

Singh A-K, Yadav D, Sharma N, Jin J-O. Dipeptidyl Peptidase (DPP)-IV inhibitors with antioxidant potential isolated from natural sources: A novel approach for the management of diabetes. Pharmaceuticals, (2021); 14(6): 586.

Naz F, Malik A, Riaz M, Mahmood Q, Mehmood MH, et al. Bromocriptine therapy: Review of mechanism of action, safety and tolerability. Clinical and Experimental Pharmacology and Physiology, (2022); 49(8): 903-922.

Bandala C, Cárdenas-Rodríguez N, Mendoza-Torreblanca JG, Contreras-García IJ, Martínez-López V, et al. Therapeutic Potential of Dopamine and Related Drugs as Anti-Inflammatories and Antioxidants in Neuronal and Non-Neuronal Pathologies. Pharmaceutics, (2023); 15(2): 693.

Oshige T, Nakamura Y, Sasaki Y, Kawano S, Ohki T, et al. Bromocriptine as a potential glucose-lowering agent for the treatment of prolactinoma with type 2 diabetes. Internal Medicine, (2019); 58(21): 3125-3128.

Keche Y. Bromocriptine mesylate: Food and Drug Administration approved new approach in therapy of non-insulin dependant diabetes mellitus with poor glycemic control. Journal of Pharmacy And Bioallied Sciences, (2010); 2(2): 148.


  • There are currently no refbacks.