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Drugs used in Diabetes

Different Anti-diabetic medicines act differently. We should be aware of the effect of different medicines on our body.

Over time, a healthy lifestyle may not be enough to keep blood glucose levels under control and people withT2DM may need to take oral medication. The different types of drugs used in diabetes management are described below:

  • BIGUANIDES
    • MOA: Biguanides decreases hepatic glucose production, decrease gastrointestinal glucose absorbtion, and increase target cell unsulin sensitivity.
      • Demonstrates HbA1c reduction of approximately 11mmol/mol (1%)
      • Acts as first-line therapy for T2DM
      • Negligible to mild effects on weight & reduction in cardiovascular risks
    • Side effects: Gastrointestinal upset, reduces eGFR & vitamin B12
    • Drugs: Metformin, Phenformin, Buformin
  • THIAZOLIDINEDIONES
    • MOA: Acts as insulin sensitizers, increases glucose uptake in skeletal muscle, by decreasing lipolysis in adipose tissue and decreasing hepatic glucose output.
      • 1% reduction in HbA1c
      • Rosiglitazone has some cardiovascular effects
      • Some concerns regarding bladder cancer, heart failure and bone fractures
    • Side effects: Weight gain & fluid retention
    • Drugs: Pioglitazone, Rosiglitazone
  • SULPHONYLUREAS AND MEGLITINIDES
    • MOA: Sulphonylureas (SU) stimulate insulin secretion from the β-cell by binding to a specific cell-surface receptor.
      • Meglitinides are a short acting form of sulphonylureas 0.9-3% reductions in HbA1c
      • Useful only if there is β-cell activity
      • Some concerns regarding bladder cancer, heart failure and bone fractures
    • Side effects: Hypoglycaemia, weight gain (2-4kg) & impaired renal function
    • Drugs:Glimepiride, Glyburide, Glipizide; Meglitinides-Repaglinide, Nateglinide
  • GLP-1 RECEPTOR AGONIST
    • MOA: Mimics the effect of endogenous incretin hormone released by gut cells in response to food intake, promoting pancreatic islet activity.
      • Improves glucose-dependent insulin secretion & suppresses glucagon secretion
      • Slows gastric emptying
      • 1-2% reduction in HbA1c
    • Side effects: Gastrointestinal upset & increased risk of hypoglycaemia if used with sulphonylurea
    • Drugs: Albiglutide, Dulaglutide, Exenatide
  • SODIUM-GLUCOSE LIKE COTRANSPORTER-2 INHIBITORS (SGLT2i)
    • MOA: SGLT2 found in the loop of henle, inhibits glucose reabsorbtion in the kidneys.
      • HbA1c reductions of approximately 1-2%
      • Weight loss (2-3kg)
      • BP reduction (2-5mmHg) & reduced cardiovascular risk
    • Side effects: Genitourinary and urinary tract infections; diabetic ketoacidosis (1:1000)
    • Drugs: Canagliflozin, Dapagliflozin, Empagliflozin, Ertugliflozin
  • DPP-4 INHIBITORS
    • MOA: Prolongs the action of endogenous GLP-1 to stimulate insulin secretion and suppresses glucagon release.
      • HbA1c reductions of approximately 0.7-0.9%
      • No effect on weight
      • Low risk of hypoglycaemia, unless used with sulphonylurea or insulin
      • Linagliptin is safe for patients with chronic kidney disease, stage 5
    • Side effects: Gastrointestinal upset
    • Drugs: Sitagliptin, Vildagliptin, Saxagliptin, Linagliptin, Alogliptin
  • INSULIN
    • MOA: Increase glucose uptake inskeletal muscle.
      • Most effective hypoglycaemic agent
      • Capable of lowering any elevated HbA1c level to or close to the therapeutic goal
      • HbA1c reduction of approximately 0.8-3% or more
      • Requires ongoing patient education and self-management
    • Side effects: Hypoglycaemia & Weight gain