Pathogenesis of diabetes is complex and there is an interplay between genetic and environmental factors. While it is impossible to change genetic conditions at present, we do have an impact on the environmental ones. Symptoms of both Type 1 & Type 2 diabetes usually increase slowly, and therefore the patient does not pay attention to them for a long time. If diabetes is diagnosed early, and treatment is carefully planned and carried out, it is possible in many cases to achieve recovery from the clinical symptoms. Nowadays we have many modern drugs available that greatly facilitate good metabolic alignment of Type 1 & Type 2 diabetes, but till 90s pharmacological treatment was limited to insulin, metformin and sulfonylurea. Treatment for Type 1 & Type 2 diabetes must be undertaken with a view to reducing insulin resistance. Studies show that proper diet and physical activity are much more effective in preventing the development of Type 1 & Type 2 diabetes than any drug available and they are both first treatment of choice. If this is not satisfactory, or if the patient is unsuccessful, pharmacotherapy is needed. Metformin is most often used at the beginning. If the treatment applied does not give satisfactory results, it is necessary to extend the pharmacotherapy – in this case, incretin drugs and Sodium-glucose linked transporter type 2 inhibitors (SGLT2 inhibitors) are recommended. Acarbose preparations (alpha- glucosidase inhibitors) are also used as supportive treatment. Currently, drugs from the sulfonylurea group are being introduced less and less often, as their use may cause hypoglycemic conditions as well as weight gain. When the use of oral medications appears to be insufficient for metabolic control, the inclusion of injections of insulin is considered.
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