European Journal of Clinical Pharmacology · Nov 6, 2026

Clinical pharmacology of antidiabetic drugs: an update

By Wichaiyo S

Purpose This review describes the updated pharmacology of antidiabetic drugs and its translation into clinical applications. Methods English language literature published from January 1, 1998 to July 25, 2026 was collected using PubMed, ScienceDirect, and Ovid. Research articles, reviews, and clinical practice guidelines were included for discussion. Results Currently, ultra-long-acting basal insulins are emerging, allowing less frequent injections. Glucagon-like peptide 1 receptor agonists (GLP-1RAs), tirzepatide, and sodium-glucose cotransporter-2 inhibitors (SGLT2is) have novel pharmacodynamic properties and clinical evidence of cardiorenal and metabolic benefits, supporting their important roles in individuals with type 2 diabetes (T2D) who have high cardiorenal risk. Because of their effects on weight reduction, GLP-1RAs (semaglutide, liraglutide, and orforglipron) and tirzepatide are approved for the treatment of obesity. Furthermore, SGLT2is (empagliflozin, dapagliflozin, and sotagliflozin) provide cardiorenal benefits, with supporting potential mechanisms, in individuals with heart failure and chronic kidney disease. Conventional oral drugs (e.g., metformin, thiazolidinediones, dipeptidyl peptidase-4 inhibitors, sulfonylureas, meglitinides, and α-glucosidase inhibitors) lack sufficient pharmacologic and clinical data on cardiorenal benefits, suggesting their roles as adjunctive therapies. Novel candidates, including triple incretin hormone agonists (acting on GLP-1, glucose-dependent insulinotropic polypeptide [GIP], and glucagon receptors), GLP-1RA–GIP antagonism-based therapies, amylin analogues, and new dual SGLT1/2 inhibitors, show promising results for glycemic control and weight loss. Conclusion Overall, a comprehensive understanding of the pharmacologic characteristics of antidiabetic drugs promotes appropriate drug use for the management of T2D and cardiometabolic diseases and helps avoid undesirable events. Ongoing investigations of novel approaches may contribute to improved patient care in the future.

doi.org/10.1007/s00228-026-04219-z PubMed 42993255 Interventions