Authors: Elianna Umana Kimura, Ethan Liu, and Adeline Sale
Mentor: May Sin Ke. May is currently a doctoral candidate in the Department of Oncology at the University of Oxford.
Abstract
This review paper analyzes current research on type 2 diabetes, featuring treatments like antidiabetic medications, bariatric surgeries and sodium-glucose cotransporter-2 (SGLT2) inhibitors. Considering the increasing number of citizens in the United States living with type 2 diabetes, it is of the utmost importance to identify new options for diabetes treatment. This paper investigates the numerous research paths on furthering current treatment strategies. For instance, antidiabetic medications enhance insulin secretion, slows gastric emptying, and reduces appetite. Allowing less risks for high blood sugar levels and fluctuating weight gain/loss for individuals. Bariatric surgery alters the way the body’s digestive system works, by reducing the size of the stomach, hormones working in the gut that regulates hunger are adjusted, making the body feel full faster. SGLT2 inhibitors are an orally administered drug that is used to lower blood sugar by blocking the sugar absorption in the kidneys’ blood filter, glomeruli. In this review, we outline the current propositions in diabetes research by evaluating the numerous clinical trials and experiments performed for various treatment strategies. We presented the challenges and limitations of these approaches and identified possible future directions for diabetes research.
Introduction
Type 2 diabetes is a disability that limits the function of the endocrine system. The endocrine system makes hormones that carry information from one set of cells to the next. People diagnosed with type 2 diabetes experience high blood sugar levels because their body does not make enough of a hormone called insulin. High blood sugar levels over a long period of time can lead to other health problems like heart attacks and strokes. About 1.2 million Americans are diagnosed with diabetes every year with around 50% struggling with therapeutic inertia, a resistance to treatment (Davies et al., 2022). Diabetes, left untreated, can damage blood vessels and nerves necessary for other organs, including your eyes, heart and liver. Diabetes has been the eighth leading cause of death since 2021, in the United States, leading to an average of 399,401 deaths annually. Even though people with diagnosed diabetes account for 1 in every 4 health care dollars spent in the United States, the total annual cost of diabetes is $412.9 billion. $306.6 billion is directly for the medical costs, like insulin and testing. The other $106.3 billion is attributed for the lost productivity at work, unemployment from chronic disability, and premature mortality (or reaching death before your life expectancy).
People with insulin resistance have a low insulin sensitivity, which affects about 40% of adults, ages 18-44, living in the United States (Freeman et al., 2023). High insulin sensitivity allows the cells in the body to use blood glucose more effectively, reducing blood sugar. However, in diabetes, although a person may produce enough insulin, cells become resistant. This leads to excess blood sugar as the pancreas overworks to produce more insulin until it eventually wears out and stops producing enough insulin.
Obesity can be the main factor when driving type 2 diabetes, which in turn leads to detrimental effects on the kidney and cardiovascular systems. Excessive weight leads to high blood glucose levels, which becomes a primary factor for driving cardiovascular accidents. (Ashraf and Baweja, 2013). Increased fat leads to increased blood volume, therefore forcing the heart to function harder than needed, as well as pancreatic cells becoming less sensitive to insulin execution (Ashraf and Baweja, 2013). As this continues, the walls of blood vessels contribute to plaque building up, eventually escalating the risks of cardiovascular accidents (Timon et al., 2014). High blood pressure can also damage the walls of kidney structures, subjecting the kidneys' filtering network to excess pressure. As the kidneys begin to deteriorate, they can't function in filtering waste and fluid flow, further promoting kidney decline (Sheen and Sheu 2012). In both cardiovascular and kidney systems, obesity triggers the RAAS - the renin-angiotensin-aldosterone system which includes important proteins and enzymes that regulate blood pressure and fluid balance. (Pittampalli et al., 2023). Obesity creates a complicated multifaceted, interconnected relation for type 2 diabetes; as one system relapses, the other systems follow.
Limitations in Current Standard of Care
There are many treatment options for type 2 diabetes. For example, metformin, which lowers glucose production in the liver to increase one’s sensitivity to insulin, is commonly used to treat type 2 diabetes (Raghuvanshi et al., 2023). Metformin, along with other drugs can be prescribed to patients who rely on drug usage. Still, these types of medications are expensive. In a recent study involving 710 type 2 diabetic subjects, many claimed a common reason for not treating diabetes: the expenses for health care coverage (Pihoker et al., 2023). This makes it difficult for type 2 diabetic patients to navigate themselves for treating their disease. However, many lifestyle changes such as exercising well, a healthy amount of sleep, and a nutritious diet may help increase insulin sensitivity.
Current Areas of Research
Hemoglobin A1c or glycosylated hemoglobin (HbA1c), is a blood test that exhibits average glucose levels over a course of 2 to 3 months (Parker et al., 2018). The test depends on a part of the red blood cell system whose job depends on carrying oxygen through the body, the hemoglobin. Hemoglobin, Hb, are proteins in red blood cells that transport oxygen. This test is to screen diabetes, both to detect prediabetes, help diagnose type 2 diabetes as well as manage treatment plans to treat the disease. A high A1c typically means a higher risk of future diabetic complications (Parker et al., 2018). The higher the A1c level is, the poorer the blood sugar control and the higher the risk for diabetes complications.
Beta cells, (B-cells) are cells responsible for producing and releasing insulin located in the pancreas (Bartolomé, 2023). As cells become less receptive to insulin, the b-cells then produce more insulin. However, if the insulin resistance continues, these b-cells begin to lose their systemic duty from being overburdened, which in turn leads them to no longer create their insulin (Bartolomé, 2023). B-cell malfunctions lead to high glucose levels, and further the progression of type 2 diabetes. It's important to preserve the b-cells' functions, as it's a key to delay and hinder the progression of the disease.
Many treatments are being thoroughly researched and studied, in hopes for the long-term remission of diabetes. Antidiabetic medications have been the most common source of treatment for diabetes, specifically targeted toward patients diagnosed with type 2 diabetes (Raghuvanshi et al., 2023). Even so, other opportunities are providing striking results toward the suspension of diabetes. Bariatric surgeries and the advancements in gene therapy allow for specific modifications of some of the symptoms of type 2 diabetes in the long run.
Bariatric surgery changes how the digestive system works in ways that can be beneficial to people with type 2 diabetes. It makes you feel full much faster, reducing how much food you intake (Courcoulas et al., 2020). Bariatric surgery changes how the hormones in the gut work, affecting how the body makes and produces insulin. It increases insulin sensitivity by raising the amount of bile acid the body makes. It can improve the ways the body uses insulin, leading to lower amounts of sugar in the blood. Though, because surgery can be more at risk for patients, treatments of newly advanced medications and prescriptions remain a viable option. This includes drugs like metformin, SGLT2 inhibitors and GLP-agonists.
Drugs are a common method of treating types of diabetes and help control blood sugar levels in a variety of ways. Metformin is the most commonly prescribed medication, and works to reduce the amount of insulin released into the body from the liver and make insulin much more sensitive, allowing lower blood sugar levels. SGLT2 inhibitors are a set of medications used to treat type 2 diabetes. There are currently four types: canagliflozin, dapagliflozin, empagliflozin and ertugliflozin. They function by blocking SGLT2 in the renal systems by disposing glucose from the urine (Tsushima et al., 2023). Some work through stimulating the pancreas to secrete needed insulin such as Glucagon-like peptide-1 receptor agonists (GLP-1 RA) which mimics GLP-1 a hormone that naturally emitted after consuming food (Hinnen et al., 2017). Both SGLT2 inhibitors and GLP-1 agonists can also be used together in a combined therapy group to further provide successful outcomes. This review aims to explore various treatment strategies for type 2 strategies in further detail.
Results
The different types of treatments for type 2 diabetes have shown promising results for future long-term remission. The treatments available are a variety of bariatric (weight-loss) surgery and antidiabetic medications. This section focuses on the research that was gathered, in those areas, having impactful data in alternative ways for a decrease in type 2 diabetes. Of the collected treatments and their data, antidiabetic medications show higher remission rates than bariatric surgeries (Figure 1). The following sections will discuss these treatment strategies in further detail.
Figure 1. Results of the different treatments’ research. This figure is an overview of the different types of treatments found for type 2 diabetes and the results shown from the clinical trials for each treatment in the research area.
Bariatric Surgery
Bariatric surgery changes how the digestive system works, in ways that can be beneficial to people with type II diabetes. It makes you feel full much faster, reducing how much food you intake. Bariatric surgery changes how the hormones in the gut work, affecting how the body makes and produces insulin. It increases insulin sensitivity by raising the amount of bile acid the body makes leading to lower amounts of sugar in the blood (Feleke et al., 2024).
Sleeve gastrectomy and a Roux-en-Y gastric bypass are common examples of weight-reduction surgery methods. A Roux-en-Y gastric bypass is when the surgeon divides the top of the stomach from the rest, so that food will go to the small pouch and bypass to the top of the small intestine, resulting in less absorption calories, while feeling full. A sleeve gastrectomy is similar to a Roux-en-Y gastric bypass in which it removes a large portion of the stomach to make you feel full faster. This operation also consists of lowering a hormone that makes you feel hungry, called ghrelin. Studies and clinical trials on long-term outcomes of bariatric surgery have shown individuals that undergo bariatric surgery have higher rates of diabetes remission for the reason that they have more control over their blood glucose levels (Courcoulas et al., 2020; Ghanem et al., 2024; Courcoulas et al., 2024).
For instance, at the 7 year mark in their clinical trial about the long-term glycemic control and safety between bariatric surgeries and metabolic lifestyles, the HbA1c test decreased by 0.2% from a baseline of 8.2%, in the medical/lifestyle group (Courcoulas et al., 2024). A total of 262 randomized participants were selected to undergo different types of treatments for their type 2 diabetes. In the bariatric surgery group, the HbA1c test decreased from a baseline of 8.7%, by 1.6%. The between-group difference was -1.4% at the 7 year mark and -1.1% at the 12 year mark. The bariatric surgery group used fewer antidiabetic medications and the remission rate was far greater (6.2% in the medical/lifestyle group vs. 18.2% in the bariatric surgery group, Courcoulas et al., 2024). The importance of this clinical trial was to determine long-term glycemic control and safety of bariatric surgery compared with medical/lifestyle management of type 2 diabetes.
In similar randomized clinical trials the outcomes in the long-term observational studies of obese patients with type 2 diabetes, bariatric surgery was associated with more frequent diabetes remission and fewer complications than usual care (Figure 2). In comparison to lifestyle intervention alone, for type 2 diabetes remission, surgical treatments are more effective. Recent research showed partial or complete type 2 diabetes remission was achieved for participants in the Roux-en-Y gastric bypass group, by 30%, and no remission was achieved for participants in the lifestyle weight-loss intervention group (Courcoulas et al., 2020). Diabetes remission was assessed at 5 years into the clinical trial. At 5 years, those in the Roux-en-Y gastric bypass group had the largest percentage of individuals (56%) who did not require any medications for type II diabetes compared with those in the lifestyle weight-loss intervention (0%) group. The odds of type 2 diabetes recurrence after regaining the original weight, according to Ghanem et al. (2024), after a sleeve gastronomy is 5.5 times higher than that of gastric bypass. These findings suggest that bariatric (or metabolic) surgery could potentially be a feasible remission strategy for the long-term remission of type 2 diabetes. Moreover, research has shown that type 2 diabetes remission rates after these procedures are more effective than prescribed medication and intensified weight-loss lifestyles.
Figure 2. Comparison of the remission rates between different types of bariatric surgeries. The x-axis represents the different types of bariatric surgeries performed in three different clinical trials. The y-axis represents the remission rates of the three clinical trials after the bariatric surgery was performed on the participants with type 2 diabetes. The gastric bypass trial in 2020 had a short time to track the rate of remission compared to the gastric bypass trial in 2024 (Courcoulas et al., 2020; Ghanem et al., 2024; Courcoulas et al., 2024).
SGLT2 Inhibitors
SGLT2 inhibitors are a set of orally administered prescription drugs to help treat type 2 diabetes, with research exhibiting treatments of cardiovascular and kidney disease, a common attached effect of type 2 diabetes. The inhibitors are used to lower blood glucose by blocking glucose absorption in the kidneys’ glomeruli (Padda et al., 2023). Accelerated levels of glucose in the urine eventually function to lower blood sugar without directly activating insulin release in the pancreas (Padda et al., 2023). SGLT2 alters the action of SGLT2 proteins to help the kidneys reabsorb the glucose by itself: the pathway follows after reabsorbing in the proximal tube, the inhibitors than reabsorb the glucose from the tubular lumen which then there glucose moves and leaves the bloodstream by the transporters (Pittampalli et al., 2018). A benefit of the medication is that it is independent of B-cell function, insulin secretion, and resistance (Padda et al., 2023). Because of this, hypoglycemia is infrequent. Currently, only four types of medication in the class are available, which are all FDA approved: empagliflozin, canagliflozin, dapagliflozin, and ertugliflozin (Padda et al., 2023). Despite no individual trial of the medication and link with glycemic control, placebo controlled trials, placed in order to not include bias, are shown to have improved HbA1c from 0.6 to 1.9 percentage points if treated with metformin. Data also shows it increases from 0.4 to 0.6 percentage points if added to anti-hyperglycemic factors (Tsushima et al., 2021). However, because obesity develops the risk of cardiovascular and renal disease, it represents a key factor for treating type 2 diabetes; the inhibitors work in benefiting those regions, marking a valuable aspect of the SGLT2 treatment plan. The first clinical trials scrutinize cardiovascular effects.
Four placebo based clinical trials were conducted to directly correlate cardiovascular effects with the specific SGLT2 drug. The results were compared to other drugs like DPP-4 inhibitors, specifically sitagliptin and linaglipton and GLP-Agonists (D’Andrea et al., 2023). The EMPA-REM-OUTCOME was the clinical trial of empagliflozin that took place in 2010-2014, with a total of 7,020 participants. This trial is shown to have reduced cardiovascular accidents by a whole 14 percent, with death by 38 percent and hospitalization by heart disease by 35 percent (Tsushima et al., 2023). The CANVAS trial for assessing canagliflozin which took place in 2009-2013, had a total of 10,142 participants. They found a 14 percent decrease in major cardiovascular accidents, and a 35 percent decrease in hospitalization, with no significant difference for cardiovascular accident-related death (Tsushima et., al 2023). The DECLARE TIMI 58 trial for dapagliflozin which took place in 2014-2016, had a total of 17,160 participants. There was no significant fluctuation for major cardiovascular effects but was seen to lower hospitalization by 27 percent, and a 17 percent for deaths (Tsushima et al., 2023). VERTS–CV, the test for ertugliflozin had 8,246 patients and took place in 2014-2017. This trial decreased hospitalization effects by 35 percent. Holistically the clinical trials had a total of 42,568 patients, with a mean average of 14.6 percent of those with heart failure and 76.3 percent having a history of cardiovascular disease. All four clinical trials show that SGLT2 inhibitors are correlated with patients with established cardiovascular disease to major cardiovascular accidents. However, they are seen as independent of those patients with lower hospitalization rates. The most significant difference was hospitalization by heart failure with over 30 percent decrease for all drugs as shown in Figure 3 below.
Figure 3. Meta Analysis of SGLT2 Drugs on Heart Failure Hospitalization. The following exhibits the risk reduction performed from the 4 clinical trials (EMPA-REG, CANVAS22, Declare-TIMI and VertisCV24) measuring all 4 SGLT2 drugs; specifically on Hospitalization rates for Heart failure. The X axis represents the type of drug, and the Y axis represents the decline compared to an unknown data set (Lansang et al., 2023).
Renal protection is another contributing factor for SGLT2 inhibitors. The inhibitors lower pressure in blood vessels for the organ, eventually preventing damage to their outside walls, therefore effectively lowering kidney disease. (Bilkan, 2012). A clinical trial named CREDENCE, a random placebo based on the inhibitor canagliflozin that took place in 2015-2017 was placed to assess type 2 diabetic patients with renal failure (Nespoux and Vallon, 2020). This was the only inhibitor that took place in a large trial with a high renal benefit. The trial has 4,401 patients and the risk for renal failure was 30 percent lower in that group, with a 34 percent decrease in renal failure-linked deaths (Vallon and Nespoux, 2020). Compared to the drug losartan, which is used to provide outcomes for diabetic patients, canagliflozin proved to be more successful than the receptor blocker as shown in the figure below (Brenner et al., 2001).
Figure 4. Relative Risk Reduction comparison between the RENAAL study and the CREDENCE trial. The following exhibits the composite risk reduction for renal failure between the Credence Trial (assessing the SGLT2 inhibitor canagliflozin) and the RENAAL Study (assessing losartan). The X axis represents the two clinical trials and the Y Axis represents the rate of reduction. Canagliflzin has a 30 percent reduction rate, having a 5 percent more success rate compared to the 25 percent assessing losartan (Brenner et al., 2001).
The EMPA-REG outcome assessed renal failure decreasing despite its purpose to assess cardiovascular disease. They found a 39 percent reduction for the renal composite of death by renal disease. Holistically, all primary renal functions reduced the risk by 45 percent, signifying a successful byproduct of the inhibitors (Tsushima et al., 2023). The EMPA-REG outcome trial also found beneficial results in relation to metabolic functions.
SGLT2 inhibitors have beneficial effects for weight loss and fluctuating high glucose blood levels, a critical aspect when finding treatments for type 2 diabetic patients. A holistic assessment scrutinizing the 4 drugs, found a mean average of 1.62 kg weight loss, 0.47 kg/m BMI decrease as well as 1.29 cm decrease in waist circumference compared to the placebo on SGLT2 patients. (Tsushima et al., 2023). Patients who took the drugs for about 24 to 26 weeks were seen to lose between 2.3 to 3.5 kg (Kim et al., 2021). With fluctuating levels of both systolic and diastolic blood pressure, an average of 3.32 mm decrease was found with the EMPA-REG outcome trial. SGLT2, along with GLP-1 receptors, can deem themselves a combination therapy group, which is seen as more effective than a monotherapy group when treating patients who are obese (Tsushima et al., 2023).
SGLT2 presents itself as a drug with many multifaceted positive effects, making them a valuable option when managing patients with type 2 diabetes who also have secondary high risk effects. They exhibit themselves more effectively than other drugs and insulin monotherapy and continue to be seen as a top contender when looking for viable treatment plans especially if worked along with combination therapies.
Tirzepatide
The primary goal of transitioning from a complex insulin regimen to FRCs is to simplify the treatment plan which can be extensive conventionally. Tirzepatide, sold under the brand names Mounjaro for diabetes treatment and Zepbound for weight loss was approved for chronic weight management by the European Medicines Agency to improve glycaemic control in May 2022. Tirzepatide targets both the GLP-1 and GIP receptors, which is effective as it enhances insulin secretion, slows gastric emptying, and reduces appetite allowing better health for individuals. Furthermore tirzepatide is able to be used in combination with both basal insulin and SGLT2 for better treatment results.
The usage of fixed-ratio combination of basal insulin and GLP-1 RA allows for better glycaemic (blood sugar level) control and avoids negative effects of hypoglycemia risk and fluctuation in weight commonly seen in traditional treatment methods (Haluzik et al., 2022). GLP-1 RA are agonists that cause the pancreas to secrete more insulin to which patients with type 2 diabetes have little of, mimicking a natural hormone in the stomach that is released when consuming food. This medication which has just recently been approved for use has promising potential for type 2 diabetes, with a wide range of clinical trials conducted resulting in significant positive results for patients. Ranging from combination trials to comparison with other drugs, tirzepatide shows an extensive method of success no matter the variables.
In fact, several studies such as the SoliMix trial by Rosenstock et al. have found improved results with the use of BI and GLP-1 RA compared to premixed insulin (2021). Furthermore the LixiLan randomized clinical trial evaluated the safety of GLP-1 RA and found greater reductions in average blood sugar levels and reduction in body weight compared to insulin glargine (synthetic). Results from the BEYOND trial which was conducted over 6 months, contained participants with type 2 diabetes switching over to FRC’s and GLP-1 RA showed lessened insulin dose, number of injections and frequency of hypoglycaemia (Giugliano et al., 2021). This drug has specifically improved body weight, lower hypoglycemia leading to overall better patient satisfaction. Despite that, overall findings show that GLP-1 RA is a promising treatment for individuals struggling with type two diabetes and need treatment intensification with benefits over traditional premixed insulin. The trial provided data on the beneficial effects of tirzepatide on weight loss and improved BMI for people suffering with obesity and possibly type two diabetes as unhealthy lifestyles and heavier weights are correlated to diagnosis of type 2 diabetes.
Semaglutide is currently a commonly used GLP-1 RA in clinical practice, however tirzepatide shows promising improvements over it in conducted trials. In the SURPASS-2 trial which compared both tirzepatide and semaglutide in effectiveness in a 40-week, phase 3 trial with 1879 patients. Tizapatide was superior to semaglutide in all three dose amounts (5-mg, 10-mg, and 15-mg) with a lower glycated hemoglobin level (Osumili et al., 2024). Moreover within the SURMOUNT-1 study of 2539 adults with BMI of 30 or more and overweight, the participants received a weekly amount of injected tirzepatide from while the control group were given a placebo for a timeframe of 72 weeks (Jastreboff et al., 2022). The results were staggering with −15.0% weight loss in the 5-mg group, −19.5% in the 10-mg group, and −20.9% in the 15-mg dose group (Figure 5).
Figure 5. Tirzepatide weight loss effects. The following dosage amounts and corresponding mean weight changes are shown above in the x and y axis, showing considerable weight loss with increased dosage of tirzepatide after 72 weeks (Jastreboff et al., 2022).
The main adverse effects from taking tirzepatide are gastrointestinal effects which are common in weight loss and diabetic treatments, as an increase in dosage resulted in more acute effects. In fact, further study showed tirzepatide doses had statistically significantly greater reductions in HbA1c, body weight and body mass index. HbA1c targets of less than 6.5% and 7.0% were achieved by patients taking tirzepatide meaning lessened blood glucose levels overall (Osumili et al., 2024). There were also little to no differences in experiences of nausea or vomiting from taking tirzepatide compared to semaglutide. Tirzepatide furthermore has been seen to reduce liver fat content (LFC) within the SURPASS-3 trial where participants were put on treatment with tirzepatide or synthetic insulin. MRI scans were used to observe LFC and the results after week 52 showed significantly greater LFC loss from the tirzepatide groups (Gastaldelli et al., 2022).
Another beneficial aspect of tirzepatide is its potential positive impact on cardiovascular outcomes including reduced peak and low BP by 4.8 and 1.7 mmHg (Cho et al., 2023). Tirzepatide’s use in medicine is an important growth in treatment for both type 2 diabetes and obesity. Its management offers a new approach to treating the dangerous conditions that may begin to find new methods for treatment. Yet, continued research will be necessary for determining its long-term effectiveness in the clinical space and soon tirzepatide may be a major player in the management of type 2 diabetes and metabolic diseases.
Discussion
There are varying limitations associated with treatment strategies for type 2 diabetes for both administered drugs and surgical procedures. Bariatric surgery carries both short and long term risks while being an effective management of type two diabetes. This includes acid reflux, anesthesia-related risks, chronic nausea, and vomiting which are commonly seen with bariatric surgery. While dumping syndrome, when food moves from the stomach to the small bowel too quickly, and low blood sugar are long term side effects (Hui et al., 2023). Basic surgical risks also apply in the operation meaning there is a possibility of breakage, internal bleeding, or problematic complications. The advantages of bariatric surgery should be balanced against the increased risk of nutritional deficiencies (anemia), gastrointestinal adverse events, and bone fractures in long-term follow-up after bariatric surgery. Nutritional deficiencies, including protein-calorie malnutrition and deficiencies of iron, other minerals, and vitamins, occur in 30% to 70% of patients (Courcoulas et al., 2024).
SGLT2 inhibitors address increased acid in the blood and serious urinary tract infections from the FDA due to facilitated glucose excretion in urine. Some cases have reported serious infections that elevate ketone body levels and euglycemic ketoacidosis, which are low blood glucose levels along with acidic blood levels (Pittampalli et al., 2018). The drugs are primarily not used for patients with higher renal dysfunction since the drug relies on kidney function for glucose depletion (Pittampalli et al., 2018). The inhibitors can accelerate the risk of amputation and bone fracture risk as well, particularly related to the drug canagliflozin. The CANVAS trial demonstrated that canagliflozin doubled the risk of amputations next to the placebo: from 6.3 to 3.4 per 1000 patients placed exhibiting itself as an increased risk of amputation (Pittampalli et al., 2018).
A limitation seen with tirzepatide is the fact that 1.7 % and 0.2 % of patients who received 15-mg of tirzepatide encountered a occurrence of hypoglycaemia, an abnormally low level of glucose in the blood (Frías et al., 2021). In addition, the high cost of tirzepatide may deter some patients from using the treatment. The long term effects and influence have not been fully looked into, meaning weight regain could be a possible effect of discontinuing the use of tirzepatide. Further research will be required to improve such treatment strategies. The next section will discuss various directions where future research in this field may lead.
Future Research on Treatment Strategies for Type 2 Diabetes
The current research on type 2 diabetes treatments has primarily focused on experiments related to cell alteration and technological advancements looking to provide a permanent corrective treatment for the illness. A therapeutic approach of type 2 diabetes takes a new approach by researching a regenerative preservation method of B-cells in the pancreas that create and move insulin (Khim et al., 2023). Another recent study involving B-cells expressed an ability to expand themselves, promoting cell division and additionally enhancing each individual cell functions. The Alsono lab developed a new mouse model which is able to mimic the diabetic conditions of diabetic patients that lack a protein that allows insulin to signal insulin cells, ISR2 (Stamaterism et al., 2023). By boosting a protein called CDK2, the mice's blood sugar returned back to its normal levels compared to its diabetic state attached to cyclin D2 (Stamateris et al., 2023). Increasing the activity of CDK2 resulted in B-cells packed full of insulin," said Dr. Alonso, which could lead to a breakthrough in future long term diabetic treatments as well as understanding diabetes as a whole (Stamateris et al., 2023).
Technological advancements are another emerging factor for diabetic treatments using innovative approaches to develop further efficient diabetes treatments. Nanotechnology can help both administer medications more effectively and develop new approaches for blood sugar and insulin management. Nanoscale sensors show minimally invasive insulin detection, which opens pathways for early detection in type 2 diabetes (Pathak et al., 2023). By using fluorescent lights to signal blood sensitivity in localized areas, it exhibits quicker and localized specificity in the pancreas. Nanotechnology can become another important factor used along with prescribed medication helping how medicine is administered through encapsulating the drug for their greater bioavailability (Sarmah et al., 2023). Nanotechnology working along with other technological advancements including new groundbreaking research of gene therapy has the potential to yield innovative treatments. For instance, researchers may target insulin-resistant genes and B-cell function, potentially improving the body's ability to regulate blood sugars. CRISPR-CAS9 is the gene-editing tool that prevents genes from attacking pancreas insulin cells by having precise alterations in the gene cells (Adli, 2018). Recently, research has primarily focused on insulin resistance in peripheral tissues as it boosts B-cell proliferation. As GLP-1 Receptors lead to a physiologically hard life, various degrees of success have been deemed adequate by using kinds of specifically engineered bacteria (Adli, 2018). With more continuous research, gene therapy, gene altering and nanotechnology establish themselves to be key to permanently treat type 2 diabetes.
Conclusion
In summary, this review explored various strategies to treat type 2 diabetes. Furthermore, the study explores potential future medical therapies that promise to deliver greater patient satisfaction and improved outcomes. Bariatric surgery, which includes gastric bypass and sleeve gastrectomy is a resort after the failure of diet and exercise, helping lose weight and reduce obesity. SGLT2 and tirzepatide are prescription medicines that follow the same goal of lowering average blood glucose levels, however they go through different steps. SGLT2 prevents the reabsorption of glucose in the kidneys while tirzepatide mimics the GLP-1 hormone which normally initiates insulin secretion. In fact, the combination of the two drugs work especially well, showing beneficial effects. These treatment techniques show a variety of approaches to type 2 diabetes and only continue to be bettered by medical specialists, such as current limitations within surgery and side effects from prescription drugs. With future clinical trials conducted as well as new ideas that develop, the effectiveness and safety of type two diabetes treatment would be greatly improved.
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