Achieving glycemic control and sustaining functional pancreatic β-cell activity remains an unmet medical need in the treatment of type 2 diabetes mellitus (T2DM). Glucokinase activators (GKAs) constitute a class of anti-diabetic drugs designed to regulate blood sugar levels and enhance β-cell function in patients with diabetes. A significant progression in GKA development is underway to address the limitations of earlier generations. Dorzagliatin, a dual-acting GKA, targets both the liver and pancreas and has successfully completed two Phase III trials, demonstrating favorable results in diabetes treatment. The hepato-selective GKA—TTP399— emerges as a strong contender, displaying clinically noteworthy outcomes with minimal adverse effects. This paper seeks to review the current literature, delve into the mechanisms of action of these new-generation GKAs, and assess their efficacy and safety in treating T2DM based on published pre-clinical studies and clinical trials.

Naegleria fowler, also known as brain-eating amoeba is a thermophilic microorganism that causes primary amoebic encephalitis (PAM) having >98% mortality rate. To date, there are no specific drugs identified to treat this disease. N. fowleri expresses only one form of hexokinase i.e. glucokinase (nGLK) unlike humans that express four isozymes of hexokinase including glucokinase (hexokinase IV) or hGLK that is critical for the first step of glycolysis. Until now, there have not been many studies on glucokinase as a drug target to treat PAM, hence, this study provides an exhaustive analysis of this relatively novel drug target. Thus, it was hypothesized that amoebic glucokinase can arrest carbohydrate metabolism and assist regulating its virulence. To find suitable antagonists to inhibit the activity of nGLK, we first tested the present recommended drugs by the CDC on their ability to bind nGLK. Interestingly our studies show that many of the present recommended drugs can inhibit both amoebic (nGLK) and human (hGLK) homologs of glucokinase. We identified new inhibitors for nGLK and further explored suitable hGLK antagonists for the potential treatment of diabetes. Despite significant structural differences between nGLK and hGLK, it was interesting to note that all our screened inhibitors bound with both nGLK and hGLK. Levomefolic acid; Ziprasidone; and Risperidone were found to be more suited to treat PAM while, Simeprevir; Indacaterol; Crizotinib and Mocetinostat were found to be suited for treating diabetes. The selections were based on multiple criteria including binding affinity; ADME scores; absorption; and its ability to cross the blood brain barrier. This study identifies multiple drugs that have potential not only to treat PAM but also to treat diabetes and also use for lab based biochemical assays for glycolysis inhibitors.