Type 2 diabetes, the most common form of diabetes, affects more than 800 million adults worldwide. People with type 2 diabetes show hyperglycaemia as a result of insulin resistance, and impairment in insulin and glucagon secretion. If type 2 diabetes isn’t well controlled, people can develop microvascular, macrovascular and neuropathic complications, resulting in retinal, renal, neuropathic and vascular disease, along with autonomic and peripheral nerve damage. Type 2 diabetes has societal, environmental and genetic risk factors, and its numbers are rising in children and adolescents. [1-3]
According to Precedence Research, the worldwide type 2 diabetes market is expected to hit $40.1 billion in 2025, rising to $76.4 billion by 2034. The North American market makes up around 36% of the total market, the largest market share overall. Sales for diabetes treatment constitute more than three quarters of the metabolic disorders market. [4]
Management and treatment approaches
The aim for type 2 diabetes is to manage blood glucose levels. The NICE guidelines in the UK suggest an individualised approach based on needs and circumstances, supported by patient education. The recommendations include: [5]
· Healthy eating, exercise, weight loss and stopping smoking
· Diagnosing and managing hypertension
· Monitoring HbA1c and setting an individualised target
· Blood glucose monitoring – self-monitoring or intermittently scanned/real-time continuous glucose monitoring
· Drug treatment:
o First-line – metformin, SGLT2 inhibitors
o Further treatment options – DPP 4 inhibitors, pioglitazone, sulfonylureas, insulin
· Managing complications, such as periodontitis, gastroparesis, neuropathy, foot problems, chronic kidney disease, erectile dysfunction, eye disease and cardiovascular disease.
Glucose control can be improved by the use of continuous glucose monitoring (CGM) with both insulin and non-insulin therapies, and automated insulin delivery systems with associated CGM. Early good blood glucose control reduces the risk of diabetic complications in type 2 diabetes. A 24-year follow up of a 20-year trial of intensive blood control with oral sulfonylurea or insulin injections following diagnosis showed 10% fewer deaths, 17% fewer heart attacks, and 26% fewer diabetic complications. Using metformin resulted in 31% fewer heart attacks and 20% fewer deaths. [6]
Moving prescribing from a glucose-centric focus to a complication-centric focus, where interventions are tailored to managing co-morbid conditions, may help the outcomes for patients with type 2 diabetes. [7]
New approaches in Type 2 diabetes
GLP-1 agonists have proved highly successful in the treatment of type 2 diabetes, with sales estimated to reach $174.7 billion worldwide by 2035, more than double those in 2024, according to S&P Global; this covers obesity as well as diabetes indications. Leading drugs include Mounjaro (Eli Lilly’s tirzepatide) and Ozempic/Rybelsus (Novo Nordisk’s semaglutide). The companies developing the next-generation GLP-1 drugs, in Phase 2 and Phase 3 development, include: [8]
· Zealand Pharma
· Pfizer
· Amgen
· Structure Therapeutics
· Altimmune
· Viking Therapeutics
· Merck
· Roche/Genentech
· AstraZeneca
· Terns Pharma
Insulin treatment plays an important role in treating type 2 diabetes, but it comes with a risk of hypoglycaemic episodes, which are associated with unpleasant side effects such as confusion, anxiety, and weakness, or even seizures, unconsciousness and death. To meet this need, glucose-sensitive treatments have been sought for decades. As an example, researchers at Novo Nordisk are developing NNC2215, a modified insulin molecule that incorporates a glucose-sensitive switch. When glucose levels are low, the insulin remains inactive; when glucose levels rise, the insulin is activated. This molecule is in preclinical trials, and the approach has potential to improve outcomes and reduce adverse effects and complications for patients with type 2 diabetes. [9]
The effecti...
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