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Antidiabetic medications

Anti diabetic medications are used effectively treats type 2 diabetes mellitus, allowing a good control over the sugar status. A good glycemic control will prevent microvascular complications like retinopathy or nephropathy.

 

Antidiabetic medications

Antidiabetic drug

examples

Advantages

Adverse effects

Insulin secretogouges- Sulfonylureas

Glipizide, Gliclazide, Glibenclamide, Glibornuride and Glimepiride

Stimulates insulin secretion by beta cells of the pancreas

Hypoglycemia, nausea, vomiting, antabuse effects, hyponatremia and others

Insulin secretogouges- Meglitinides

Repaglinide, Nateglinide

Stimulates insulin release from pancreatic beta cells.

Hypoglycemia is faster and shorter compared to sulfonylureas

Insulin enhancers- Thiozolidinediones

Pioglitozone, Rosiglitazone

Decrease of hyperglycemia, glycosylated hemoglobin, plasma free fatty acids.

Weight gain, fluid retention, heart failure, and liver disturbances

Alpha-glucosidase inhibitors

Acarbose,Miglitol

Decreases post-prandial hyperglycemia.

Abdominal flatulence, bloating, diarrhea and pain.

Aldose reductase inhibitors

Tolrestat, Imerestat, Vitamin-C 100mg/day

Reduces sorbitol accumulation in RBC’s

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Insulin enhancers- Biguanides

Metformin

Decreases hyperglycemia without risk of hypoglycemia. Suppresses appetite- useful in obese individuals

Lactic acidosis, nausea, vomiting and diarrhea.

 

 

Newer class of drugs

Testosterone treatment is very efficient in insulin resistance.

Peptide analogues

  • Glucagon like peptide analogues- Exenatide
  • Dipeptidyl pepditase-4 inhibitors- Sitagliptin
  • Amylin analogue- Pramlintide

Treatment of type II diabetes

 

Monotherapy

Add

Sugars still higher the add

Obese

Metformin

Sulfonylureas

Pioglitozone/Exenatide/Insulin

Non obese

Sulfonylurea or Metformin

Metformin or Sulfonylurea

Pioglitozone/Exenatide/Insulin

Elderly

Low dose Sulfonylurea

Switch to simple insulin regimen

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