What are the oral hypoglycemic drugs?
Oral Hypoglycemic MedicationsSulfonylureas (glipizide, glyburide, gliclazide, glimepiride)Meglitinides (repaglinide and nateglinide)Biguanides (metformin)Thiazolidinediones (rosiglitazone, pioglitazone)α-Glucosidase inhibitors (acarbose, miglitol, voglibose)More items...•
What are the five types of oral glycemic?
Currently, there are five distinct classes of hypoglycemic agents available, each class displaying unique pharmacologic properties. These classes are the sulfonylureas, meglitinides, biguanides, thiazolidinediones and alpha-glucosidase inhibitors.
What are examples of oral antidiabetic medications?
The four major classes of oral antidiabetic medications are (1) the secretagogues (sulfonylureas, meglitinides), which increase insulin availability; (2) the biguanides (metformin), which suppress excessive hepatic glucose release; (3) the thiazolidinediones or glitazones (rosiglitazone, pioglitazone), which improve ...
How many types of antidiabetics are there?
The major classes of oral antidiabetic medications include biguanides, sulfonylureas, meglitinide, thiazolidinedione (TZD), dipeptidyl peptidase 4 (DPP-4) inhibitors, sodium-glucose cotransporter (SGLT2) inhibitors, and α-glucosidase inhibitors.
What is the safest oral medication for type 2 diabetes?
Most experts consider metformin to be the safest medicine for type 2 diabetes because it has been used for many decades, is effective, affordable, and safe. Metformin is recommended as a first-line treatment for type 2 diabetes by the American Diabetes Association (ADA).
What is the new pill for diabetes?
In May 2022, the FDA approved Lilly's new medication Mounjaro (also known as tirzepatide) for type 2 diabetes management, in addition to diet and exercise. This first-in-class medication has been shown to improve glucose levels and also dramatically improve weight in clinical trials.
Which is the best tablet for diabetes?
What Are the Best Drugs to Treat Diabetes?Insulin (long- and rapid-acting) ... Metformin (biguanide class) ... Glipizide (sulfonylurea class) ... Glimepiride (sulfonylurea class) ... Invokana (sodium glucose cotransporter 2 inhibitor class) ... Jardiance (SGLT2 class) ... Januvia (dipeptidyl peptidase 4 inhibitor)More items...•
What is the most common diabetic medication?
Insulin. Insulin is the most common type of medication used in type 1 diabetes treatment.
What is the most effective treatment for diabetes?
Metformin (Fortamet, Glumetza, others) is generally the first medication prescribed for type 2 diabetes. It works primarily by lowering glucose production in the liver and improving your body's sensitivity to insulin so that your body uses insulin more effectively.
Why is oral anti diabetic medication used?
Oral diabetes medicines (taken by mouth) help control blood sugar (glucose) levels in people whose bodies still produce some insulin, such as some people with type 2 diabetes. These medicines are prescribed along with regular exercise and changes in the diet.
What are the classes of antidiabetics?
Currently, six classes of oral antidiabetic drugs (OADs) are available: biguanides (e.g., metformin), sulfonylureas (e.g., glimepiride), meglitinides (e.g., repaglinide), thiazolidinediones (e.g., pioglitazone), dipeptidyl peptidase IV inhibitors (e.g., sitagliptin), and α-glucosidase inhibitors (e.g., acarbose).
What are antidiabetics used for?
antidiabetic drug, any drug that works to lower abnormally high glucose (sugar) levels in the blood, which are characteristic of the endocrine system disorder known as diabetes mellitus.
What oral hypoglycemic agents can be used with insulin?
For these reasons, metformin has been the most commonly used drug in combination with insulin. There are few limitations for the use of metformin, the most common of which include intolerance to its gastrointestinal side effects and its contraindication in renal or hepatic insufficiency (Ahmed and Goldstein 2006).
What are the different types of insulin?
The 5 types of insulin are:rapid-acting insulin.short-acting insulin.intermediate-acting insulin.mixed insulin.long-acting insulin.
Which of the following is hyperglycemic agent?
Metformin is an oral hyperglycemic agent in the biguanide class. Metformin acts by increasing peripheral glucose uptake by increasing the capacity of insulin to bind to its receptors and increasing the synthesis of glucose transporter.
What are the sulfonylurea drugs?
Sulfonylureas are a group of medicines used to treat type 2 diabetes....Some commonly prescribed sulfonylureas include:DiaBeta, Glynase, or Micronase (glyburide or glibenclamide)Amaryl (glimepiride)Diabinese (chlorpropamide)Glucotrol (glipizide)Tolinase (tolazamide)Tolbutamide.
Does metformin cause lactic acidosis?
Metformin undergoes renal excretion. Lactic acidosis can occur with the administration of metformin, but is extremely rare (occurrence of 3 cases per 100,000 patient years). Patients presenting with vague, flu-like illness should be assessed for presence of lactic acidosis.
Is metformin contraindicated for hepatic dysfunction?
Metformin is contraindicated in 1) patients with serum creatinine >1.5 (males) and >1.4 (females), 2) patients with hepatic dysfunction , 3) patients with congestive heart failure requiring pharmacologic treatment, 4) patients with a history of binge drinking, and 5) patients with acute or chronic lactic acidosis.
Can metformin be used as a first line pharmacotherapy?
Monotherapy with a sulfonylurea or metformin can be used as first-line pharmacotherapy. However, if FPG is >250 mg/dl or random blood glucose is >400 mg/dl, insulin should be considered as initial therapy. Other agents may be added if monotherapy provides inadequate control.
How does oral antidiabetic work?
Oral antidiabetic agents work in various ways to reduce blood sugar levels in people with type 2 diabetes; some stimulate insulin secretion by the pancreas, others improve the responsiveness of cells to insulin or prevent glucose production by the liver. Others slow the absorption of glucose after meals.
What are Antidiabetic agents?
Antidiabetic agents refer to all the different types of medicine involved in the treatment of diabetes. All these agents aim to reduce blood sugar levels to an acceptable range (called achieving normoglycemia) and relieve symptoms of diabetes such as thirst, excessive urination, and ketoacidosis (a serious complication of diabetes that occurs when the body cannot use glucose as a fuel source). Antidiabetic agents also prevent the development of, or slow the progression of, long-term complications of the disease, such as nephropathy (kidney disease), neuropathy (nerve damage), and retinopathy (damage to the retina of the eye).
What are the complications of antidiabetic agents?
Antidiabetic agents also prevent the development of, or slow the progression of, long-term complications of the disease, such as nephropathy (kidney disease), neuropathy (nerve damage), and retinopathy (damage to the retina of the eye). Common antidiabetic agents include:
Is insulin good for diabetes?
Type I diabetes is a condition where the body does not produce any insulin. Therefore, insulin is the only treatment effective for type 1 diabetes. Injected insulin acts just like naturally occurring insulin to lower blood glucose levels.
Diabetes review
Insulin is a hormone made naturally in the body that plays a key part in keeping us alive. Insulin’s job is to transport glucose (sugar) from the bloodstream into the body’s cells where it can be used for energy.
Key side effect of oral antidiabetic agents
A key side effect of oral antidiabetic medications is hypoglycemia, which is low blood sugar .
Sulfonylureas: glipizide (Glucotrol), glyburide (Diabeta)
Sulfonylureas are a class of oral antidiabetic medications that includes glipizide and glyburide. Patients with type 2 diabetes may be prescribed sulfonylureas to keep their blood sugar down.
Sulfonylureas patient teaching
Advise patients to take a sulfonylurea medication 30 minutes before a meal.
Meglitinides: repaglinide (Prandin)
The next category of oral antidiabetics you'll need to know are meglitinides. A key medication that falls within this class is repaglinide. They both end in "-inide"! Repaglinide is taken by patients with type 2 diabetes to lower blood sugar.
Biguanides: metformin (Glucophage)
The final oral antidiabetic class we'll cover in this article are biguanides, which include the common drug Metformin. Metformin is a drug commonly taken by patients with type 2 diabetes to lower blood sugar.
Full Transcript
Hi. I'm Cathy with LevelUp RN. In this video, I am going to cover some oral antidiabetic agents. And if you have our pharmacology second edition flashcards, definitely pull those out so you can follow along with me.
How much does an antidiabetic drug reduce HbA1C?
The average glucose-lowering effect of the major classes of oral antidiabetic agents is broadly similar (averaging a 1-2% reduction in HbA1c), alpha-glucosidase inhibitors being rather less effective. Tailoring the treatment to the individual patient is an important principle. Doses are gradually titrated up according to response.
How much does sulphonylureas lower glucose?
However, the maximal glucose-lowering action for sulphonylureas is usually attained at appreciably lower doses (approximately 50% ) than the manufacturers' recommended daily maximum.
Is Type 2 diabetes mellitus a progressive disease?
Type 2 diabetes mellitus is a progressive and complex disorder that is difficult to treat effectively in the long term . The majority of patients are overweight or obese at diagnosis and will be unable to achieve or sustain near normoglycaemia without oral antidiabetic agents; a sizeable proportion of patients will eventually require insulin therapy ...
Is insulin needed for metabolic decompensation?
Insulin is also required for metabolic decompensation, that is, incipient or actual diabetic ketoacidosis, or non-ketotic hyperosmolar hyperglycaemia. Certain comorbidities, for example presentation with myocardial infarction during other acute intercurrent illness, may make insulin the best option.
Is oral antidiabetic medicine used for diabetes mellitus?
Oral antidiabetic agents: current role in type 2 diabetes mellitus. Type 2 diabetes mellitus is a progressive and complex disorder that is difficult to treat effectively in the long term. The majority of patients are overweight or obese at diagnosis and will be unable to achieve or sustain near normoglycaemia without oral antidiabetic agents;
What is the purpose of anti-diabetic drugs?
Anti-Diabetic Drugs. Antidiabetic drugs are medicines developed to stabilise and control blood glucose levels amongst people with diabetes. Antidiabetic drugs are commonly used to manage diabetes. There are a number of different types of antidiabetic drug including:
Why do people with diabetes need antidiabetic drugs?
People with diabetes may need to take antidiabetic drugs for their whole lives in order to control their blood glucose levels and avoid hypoglycemia and hyperglycemia.
What are the DPP-4 inhibitors?
DPP-4 inhibitors such as sitagliptin ( Januvia ), saxagliptin (Onglyza), vildagliptin (Galvus) GLP-1 receptor agonists such as exenatide (Byetta) and liraglutide ( Victoza ) Some drugs are combinations of some of these drug types. One such drug, Eucreas, is a combination of vildagliptin and metformin.
Is Metformin an antidiabetic?
Antidiabetic treatment considerations for type 2 diabetes. Biguanides, such as Metformin, are commonly prescribed as a first antidiabetic medication. If biguanides are not effective on their own you may be given alternative medication either instead of, or in addition to, biguanides.
Can you take anti-diabetic medication with type 2 diabetes?
However, when diet and exercise is no longer efficient, anti-diabetic drugs may be prescribed.
Does pramlintide help with diabetes?
Type 1 diabetics must also eat properly, keep blood glucose levels from going too low or too high, and monitor blood sugar levels. In American, pramlintide, marketed as Amylin, is used in addition to insulin by some people with type 1 diabetes to further help control their diabetes. Amylin is not currently prescribed in the UK.
What type of diabetes is FDA approved for?
FDA-approved indicationsfor the use of oral hypoglycemic drugs primarily focus on type 2 diabetes mellitus.
What is the best way to manage diabetes mellitus?
The most effective management of diabetes mellitus demands an interprofessional approach involving both lifestyle modifications with diet and exercise and pharmacologic therapies as needed to meet individualized glycemic goals. Healthcare practitioners must encourage patients to combine lifestyle modifications with oral pharmacologic agents for optimal glycemic control, particularly as type 2 diabetes mellitus progresses with continued loss of pancreatic beta-cell function and insulin production. [1][2][3][4][5]
How much linagliptin is given daily?
Among the DPP- 4 inhibitors, linagliptin is available as 5 mg daily. Vildagliptin is given as 50 mg once or twice weekly, Sitagliptin as 25 mg, 50 mg, or 100 mg once daily, and Saxagliptin as 2.5 mg or 5 mg once daily.
What is the role of sulfonylureas in the pancreas?
Sulfonylureasbind to adenosine triphosphate-sensitive potassium channels (K-ATP channels) in the beta cells of the pancreas; this leads to the inhibition of those channels and alters the resting membrane potential of the cell, causing an influx of calcium and the stimulation of insulin secretion.
How much glipizide is in a tablet?
Glipizideis a 2.5 mg to 10 mg tablet, taken as a single dose or in two divided doses, 30 minutes before breakfast. Glimepiride is available as 1 mg, 2 mg, or 4 mg tablets, taken once a day with breakfast or twice a day with meals. For patients at increased risk for hypoglycemia, such as older patients or those with chronic kidney disease, the initial dose could be as low as 0.5 mg daily. Glyburide is available as 1.25 mg, 2.5 mg, or 5 mg tablets, taken as a single dose or two divided doses.
Does metformin cause lactic acidosis?
Also, in less than 1% of patients, it causes lactic acidosis, which can be life-threatening, and is precipitated by conditions predisposing to hypoperfusion and hypoxemia, such as severe renal failure (eGFR less than 30 ml/min/1.73 m2).
What are antidiabetic agents?
These drugs include alpha-glucosidase inhibitors, biguanides, dipeptidyl peptidase-4 (DPP-4) inhibitors, human amylin, incretin mimetics, meglitinides, and thiazolidinediones.
What are the contraindications and cautions for the use of agents to control blood glucose level?
The following are contraindications and cautions for the use of agents to control blood glucose level: Allergy to sulfonylureas and other antidiabetic agents. Avoid hypersensitivity reactions. Type 1 diabetes. These patients do not have functioning beta cells and would have no benefit from the drug.
What is the effect of exenatide on the pancreas?
Incretin mimetics exenatide and liraglutide mimic the effects of GLP-1: enhancement of glucose-dependent insulin secretion by the beta cells in the pancreas, depression of elevated glucagon secretion, and slowed gastric emptying to help moderate and lower blood glucose levels.
When was bromocriptine approved?
Bromocriptine, a dopamine agonist used to treat Parkinson’s disease was approved in 2009 as a CNS approach to treat type 2 diabetes.
Which DPP-4 inhibitors slow the breakdown of GLP-1?
DPP-4 inhibitors lina-, saxa-, and sitagliptin slow the breakdown of GLP-1 to prolong the effects of increased insulin secretion, decreased glucagon secretion, and slowed GI emptying.
Does metformin increase insulin secretion?
They have only a mild effect on glucose levels and do not enhance insulin secretion. They are associated with severe hepatic toxicity and GI distress. Biguanide metformin decrease the production and increases the uptake of glucose. It is effective in lowering blood glucose and does not cause hypoglycemia as the sulfonylureas do.
Does Type 1 diabetes have beta cells?
Type 1 diabetes. These patients do not have functioning beta cells and would have no benefit from the drug.
What is the drug used to treat diabetes mellitus?
Substances which lower blood glucose levels. Drugs used in diabetes treat diabetes mellitus by altering the glucose level in the blood. With the exceptions of insulin, most GLP receptor agonists ( liraglutide, exenatide, and others), and pramlintide, all are administered orally and are thus also called oral hypoglycemic agents or oral ...
What is the therapeutic combination for type 2 diabetes?
Several groups of drugs, mostly given by mouth, are effective in type 2, often in combination. The therapeutic combination in type 2 may include insulin, not necessarily because oral agents have failed completely, but in search of a desired combination of effects.
What is the advantage of insulin in type 2?
The great advantage of injected insulin in type 2 is that a well-educated patient can adjust the dose, or even take additional doses, when blood glucose levels measured by the patient, usually with a simple meter, as needed by the measured amount of sugar in the blood.
What type of diabetes is insulin?
Insulin must be used in type 1, which must be injected. Diabetes mellitus type 2 is a disease of insulin resistance by cells. Type 2 diabetes mellitus is the most common type of diabetes. Treatments include agents that (1) increase the amount of insulin secreted by the pancreas, (2) increase the sensitivity of target organs to insulin, ...
What is the difference between insulin and diabetes mellitus?
There are different classes of anti-diabetic drugs, and their selection depends on the nature of the diabetes, age and situation of the person, as well as other factors. Diabetes mellitus type 1 is a disease caused by the lack of insulin. Insulin must be used in type 1, which must be injected. Diabetes mellitus type 2 is a disease ...
How is insulin given?
Insulin is usually given subcutaneously, either by injections or by an insulin pump. In acute care settings, insulin may also be given intravenously. Insulins are typically characterized by the rate at which they are metabolized by the body, yielding different peak times and durations of action.
Does tolimidone work on insulin?
The LYN kinase activator tolimidone has been reported to potentiate insulin signaling in a manner that is distinct from the glitazones. The compound has demonstrated positive results in a Phase 2a clinical study involving 130 diabetic subjects.
Introduction
- The benefits of meeting optimal blood glucose goals in diabetic patients are now well understood due to data from many clinical trials (See Table 1). Currently, a variety of oral medications such as sulfonylureas, biguanides, thiazolidinediones, meglitinides, and alpha-glucosidase inhibitors are available to treat type 2 diabetes. Medication regime...
Sulfonylureas
- Sulfonylureas have long been the cornerstone in managing type 2 diabetes. Some examples of sulfonylureas include glyburide (Diabeta®), glipizide (Glucotrol®), and glimepiride (Amaryl®). Sulfonylureas primarily work by increasing endogenous insulin secretion; therefore, they must be used in patients with viable ß-cells. Sulfonylurea monotherapy can lower fasting plasma glucos…
Biguanides
- Metformin (Glucophage®; Glucophage® XR) is the only biguanide FDA-approved for use in the United States. Metformin acts by decreasing hepatic glucose production, decreasing glucose absorption, and increasing glucose uptake into skeletal muscle. Metformin monotherapy can lower FPG by 60 to 70 mg/dl and lower hemoglobin A1c by 1.5 to 2%. Metformin also decreases …
Thiazolidinediones
- Rosiglitazone (Avandia®) and pioglitazone (Actos®) are the two thiazolidinediones FDA-approved for use in the United States. Troglitazone (Rezulin®) was removed from the market due to hepatotoxicity. Thiazolidinediones act 1) by stimulating the PPAR (peroxisome proliferative-insulin-activated receptors) gamma receptor which cause insulin sensitizing effects on skeletal …
Meglitinides
- Repaglinide (Prandin®) and nateglinide (Starlix®) are the two meglitinides FDA-approved for use in the United States. Even though meglitinides act at the same receptor as sulfonylureas to stimulate pancreatic insulin secretion, they differ from sulfonylureas by possessing a rapid onset and short duration of action to lower post-prandial glucose. As monotherapy (in six-month trials)…
alpha-glucosidase Inhibitors
- There are two alpha-glucosidase inhibitors FDA-approved for use in the United States, acarbose (Precose®) and miglitol (Glyset®). Alpha-glucosidase inhibitors block the action of alpha-glucosidase enzymes at the brush border of the intestine. The inhibition slows the breakdown of dietary oligosaccharides and disaccharides. The delayed digestion of carbohydrates decreases …
Combination Product
- Glucovance® is a fixed combination of glyburide and metformin. This combination decreases FPG by 50 to 60 mg/dl and hemoglobin A1c by 1.7 to 1.9%. These reductions are greater than that of glyburide or metformin monotherapy. The primary advantage of Glucovance® may be increased patient compliance. The use of combination therapy provides additional glucose lowe…
Summary
- All newly diagnosed patients with type 2 diabetes should have an initial trial of dietary and exercise modifications. However, many patients require pharmacologic treatment without an optimal trial of nutrition and physical activity. Monotherapy with a sulfonylurea or metformin can be used as first-line pharmacotherapy. However, if FPG is >250 mg/dl or random blood glucose i…