Type 2 diabetes is a complex disease, with multiple etiologies, presentations, and trajectories. At the same time, diabetes care is equally dcomplicated: research has helped develop effective, as well safe, means of managing the disease which need to be chosen and prescribed carefully.

In this issue of the Asian Journal of Diabetology, we explore various evidence-based medical interventions used in diabetes care. ‘Old is gold’, goes the age-old adage, and Jain et al¹ write about the usage of low-dose glimepiride (0.5 mg) and metformin combination in persons with type 2 diabetes. Modern sulfonylureas are the backbone of type 2 diabetes management, along with metformin, and smart usage. Jain et al demonstrate that this is possible, by collating evidence from across India.

Sodium-glucose co-transporter 2 inhibitors (SGLT2i) have revolutionized not only diabetes praxis, but also the prevention and treatment of heart and kidney disease. In their comprehensive review, Unnikrishnan et al² describe how SGLT2i are being used in diabetology, cardiology and nephrology. The concept of endocrine exaptation³ is evident from the discussion about the pleiotropic benefits of this class of drugs.

Glucagon-like peptide 1 receptor agonists (GLP-1RA) are another class of glucose-lowering drugs with proven cardiovascular and renovascular safety and benefit. Till recently, only injectable GLP1-RA preparations were available, and this limited their acceptance and uptake. Baidya et al⁴ report on an oral formulation of semaglutide, and explain how it will be a game-changer in the management of type 2 diabetes. The authors cover the basic as well as clinical pharmacology of oral semaglutide, and share evidence and experience regarding its usage in clinical practice. Newer drugs are also being developed and imeglimin is the first of its class of oxidative phosphorylation inhibitors. Approved for use in Japan, this molecule has demonstrated effective glucose-lowering efficacy in type 2 diabetes. Kalra et al⁵ review its pharmacology and clinical trial data, and propose pragmatic ways for its appropriate placement in type 2 diabetes management algorithms.

The diabetes pandemic shows no signs of slowing down.⁶ Rather, it seems to be gaining momentum. This is true for the Asian Journal of Diabetology as well. We strive to improve diabetes care across Asia, and across the world. Through the evidence and experience published in our pages, our expert authors share best practices, which can help enhance the quality of our practice. Feel free to share your comments and criticism, to help us improve further. We look forward to learning together.

References

1. Jain P, Kasliwal R, Singh SK, Shah A, Bhardwaj VK, Chordia J, et al. Usage of low-dose glimepiride (0.5 mg) and metformin combination in the management of type 2 diabetes continuum in Indian setting. Asian J Diabetol. 2022;23(3):8-19.
2. Unnikrishnan AG, Khunti K, Nair T, Jagadeesh A, Purandare V. Sodium-glucose co-transporter 2 inhibitors: a novel molecule for healthcare practitioners in diabetology, cardiology and nephrology. Asian J Diabetol. 2022;23(3):20-31.
3. Kalra S, Bantwal G, John M. The exaptation of endocrine pharmacology. Indian J Endocrinol Metab. 2012;16(3):329-30.
4. Baidya A, Mishra S, Venkatanarasu A. Will oral semaglutide be a game-changer in the management of type 2 diabetes in Indian context? Asian J Diabetol. 2022;23(3):32-7.
5. Kalra S, Bhattacharya S, Shaikh S. Imeglimin: finding a place in modern diabetes pharmacotherapeutics. Asian J Diabetol. 2022;23(3):38-40.