Diabetes is a common worldwide disease and a growing global burden. The scenario in Bangladesh is even worse. In Bangladesh, 1 in 7 adults have diabetes, and about 40-60% of patients are undiagnosed. Even among those diagnosed, in about 80% of cases, Diabetes is not controlled. Therefore, the current scenario of diabetes care in Bangladesh presents a significant national economic challenge.

We know that there are different types of diabetes and various causes. Considering this, different antidiabetic drugs have emerged on the world market.

When considering the causes of death in Diabetic patients, the primary cause is cardiovascular diseases, such as heart attacks, heart failure, and strokes. The second leading cause of death is kidney failure. Diabetic patients also often have accompanying diseases like fatty liver, obesity, hypertension, and high cholesterol. These diseases are also risk factors for cardiovascular and kidney diseases. Therefore, for the total management of Diabetes Mellitus, we must consider blood glucose control and all these issues.

For Diabetes management, conventional older antidiabetic agents include insulin, metformin, and sulfonylureas like glimepiride and gliclazide. However, novel antidiabetic agents have entered the world market. These agents include

1) Incretin-based drugs like oral sitagliptin, vidagliptin, and linagliptin, and injectable liraglutide, semaglutide, and dulaglutide, which increase insulin secretion and have other effects; and

2) Sodium-glucose co-transporter inhibitors like empagliflozin, canagliflozin, and dapagliflozin, which increase glucose excretion through the kidneys.

These drugs decrease blood glucose, protect the heart and kidneys, decrease body weight, and do not cause hypoglycemia. Thus, these drugs address all the issues discussed above.

Combining two or more antidiabetic agents in a single pill addresses multiple causes of diabetes and also has beneficial effects on multiple associated diseases in diabetes. These single-pill combination drugs decrease multiple dosing frequency, reduce pill burden, and improve patient adherence and compliance. These combination single pills are now becoming popular worldwide.

The Bangladeshi pharmaceutical industry is keeping pace with the world market. There has been a tremendous growth in Bangladesh's anti-diabetic drug market. Bangladeshi companies are even exporting these drugs to many countries, including the developed world. Almost all approved antidiabetic agents worldwide are now available in our country. Our national pharmaceutical companies also produce different single-pill combination drugs. This availability provides an opportunity for our physicians and patients. These drugs are available at a lower price compared to the world market. Therefore, physicians can choose appropriate drugs for their patients, considering cost and multiple appropriate advantages. This availability may help to improve the diabetes care scenario in Bangladesh in the future.

In the pharmaceutical market of Bangladesh, there are many companies, and the market is expanding. Thus, there is a competitive marketing strategy. Ideally, this fair competition should help to ensure quality medicine for our patients at an affordable, competitive price. However, sometimes aggressive promotional marketing strategies may hinder this fair progress. Therefore, regulatory authorities, professional bodies, and consumer rights bodies should be more vigilant for a better doctor-patient-pharmaceutical-friendly pharmaceutical market.

The writer is a Senior Consultant, Endocrinology at United Hospital and President Elect, Bangladesh Endocrine Society.