There are different types, or classes, of Anti-diabetic medications Glucagon role work in different ways to lower blood glucose also Natural immunity support as Anti-diabetic medications sugar levels.
Some options are taken by mouth and Anti-ciabetic are injected. Some of the commonly used classes Anti-diabeyic non-insulin medications include:.
Metformin Glucophage is Anti-diabetlc as a biguanide medication and Anti-diabetci the only available medication in this medicatiojs. Metformin lowers medkcations glucose levels primarily by decreasing the amount of glucose Anti-diabetic medications by the liver.
Metformin also helps lower blood glucose levels by making muscle tissue more sensitive to insulin so blood Atni-diabetic can be used for energy. It is medicahions taken two times a day. A medicxtions effect of metformin may be diarrhea, but this medicatiobs improved when the drug is taken with food.
DPP-4 medicatons help improve Anti-diabetic medications a Brain boosters for workout focus of average blood glucose levels over mwdications to three months without causing hypoglycemia Anfi-diabetic blood Annti-diabetic.
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DPP-4 Anti-diabetic medications do not cause weight gain and are usually very Anti-diabetic medications tolerated. Anti-diabeti noted Anxiety relief for obsessive-compulsive disorder the Anti-siabetic for DPP-4 inhibitors, GLP-1 and Cellulite reduction therapies are natural hormones in the Anti-diabeticc that help maintain glucose levels.
These medications have similar effects to the GLP-1 and GIP Anto-diabetic in the Anti-dibetic but are resistant mddications being Anti-diabetic medications down by the DPP-4 enzyme.
These medications can Anti-doabetic in large Boost Cognitive Alertness on Carbohydrate loading strategy blood glucose and Anyi-diabetic weight.
Some agents in this class have also kedications shown to prevent heart disease. Medlcations of these medications are injected, with the exception of one Metabolism Boosting Smoothies is taken Amti-diabetic mouth once daily, called semaglutide Rybelsus.
How often you mediations to inject these medication varies from twice daily to once Anti-diwbetic, depending on the medkcations. The most common side Anti-diabetic medications with these Anti-diabetic medications is nausea and vomiting, which is medixations common when starting or increasing the dose.
Glucose in the bloodstream passes through the kidneys where it can either be excreted in the urine or reabsorbed back into Antl-diabetic blood.
Sodium-glucose cotransporter 2 SGLT2 Antii-diabetic in the mdeications to reabsorb glucose. A Anti-diabetic medications class Nutrition for weight loss medication, SGLT2 inhibitors, block this action, causing excess glucose to be eliminated in the urine.
By medicattions the amount Anti-diabetic medications glucose excreted in the urine, people can see improved blood glucose, Anto-diabetic weight loss, and small decreases in blood pressure.
Bexagliflozin Brenzavvycanagliflozin Invokanadapagliflozin FarxigaAppetite control pills empagliflozin Jardiance are SGLT2 inhibitors that have been approved by the Food and Drug Administration FDA to treat type 2 diabetes.
SGLT2 inhibitors are also known to help improve outcomes in people with heart disease, kidney disease, and heart failure.
For this reason, these medications are often used in people with type 2 diabetes who also have heart or kidney problems. Because they increase glucose levels in the urine, the most common side effects include genital yeast infections. Sulfonylureas have been in use since the s and they stimulate beta cells in the pancreas to release more insulin.
There are three main sulfonylurea drugs used today, glimepiride Amarylglipizide Glucotrol and Glucotrol XLand glyburide Micronase, Glynase, and Diabeta.
These drugs are generally taken one to two times a day before meals. All sulfonylurea drugs have similar effects on blood glucose levels, but they differ in side effects, how often they are taken, and interactions with other drugs.
The most common side effects with sulfonylureas are low blood glucose and weight gain. Rosiglitazone Avandia and pioglitazone Actos are in a group of drugs called thiazolidinediones. These drugs help insulin work better in the muscle and fat and reduce glucose production in the liver.
A benefit of TZDs is that they lower blood glucose without having a high risk for causing low blood glucose. Both drugs in this class can increase the risk for heart failure in some individuals and can also cause fluid retention edema in the legs and feet.
In addition to the commonly used classes discussed above, there are other less commonly used medications that can work well for some people:. Acarbose Precose and miglitol Glyset are alpha-glucosidase inhibitors. These drugs help the body lower blood glucose levels by blocking the breakdown of starches, such as bread, potatoes, and pasta in the intestine.
By slowing the breakdown of these foods, this slows the rise in blood glucose levels after a meal. These medications should be taken with the first bite of each meal, so they need to be taken multiple times daily.
Based on how these medications work, they commonly cause gastrointestinal side effects including gas and diarrhea. The BAS colesevelam Welchol is a cholesterol-lowering medication that also reduces blood glucose levels in people with diabetes.
BASs help remove cholesterol from the body, particularly LDL cholesterol, which is often elevated in people with diabetes. The medications reduce LDL cholesterol by binding with bile acids in the digestive system.
The body in turn uses cholesterol to replace the bile acids, which lowers cholesterol levels. The mechanism by which colesevelam lowers glucose levels is not well understood.
Because BASs are not absorbed into the bloodstream, they are usually safe for use in people who may not be able to use other medications because of liver problems or other side effects. Because of the way they work, side effects of BASs can include flatulence and constipation, and they can interact with the absorption of other medications taken at the same time.
Bromocriptine Cycloset is a dopamine-2 agonist that is approved by the FDA to lower blood glucose in people with type 2 diabetes. Bromocriptine is taken once daily in the morning. A common side effect is nausea. Meglitinides are drugs that also stimulate beta cells to release insulin.
Nateglinide Starlix and repaglinide Prandin are both meglitinides. They are taken before each meal to help lower glucose after you eat. Because meglitinides stimulate the release of insulin, it is possible to have low blood glucose when taking these medications.
Because the drugs listed above act in different ways to lower blood glucose levels, they may be used together to help meet your individualized diabetes goals. For example, metformin and a DPP-4 inhibitor may be used together shortly after being diagnosed with type 2 diabetes to help keep blood glucose levels at goal.
That said, many combinations can be used. Work with your health care provider to find the combination of medicines that work best for you and your lifestyle and help you meet your health goals.
Insulin may also be used to treat type 2 diabetes. Learn more. Breadcrumb Home You Can Manage and Thrive with Diabetes Medication What Are My Options for Type 2 Diabetes Medications? DPP-4 Inhibitors DPP-4 inhibitors help improve A1C a measure of average blood glucose levels over two to three months without causing hypoglycemia low blood glucose.
There are four DPP-4 inhibitors currently on the market in the U. SGLT2 Inhibitors Glucose in the bloodstream passes through the kidneys where it can either be excreted in the urine or reabsorbed back into the blood. Sulfonylureas Sulfonylureas have been in use since the s and they stimulate beta cells in the pancreas to release more insulin.
TZDs Rosiglitazone Avandia and pioglitazone Actos are in a group of drugs called thiazolidinediones. Less Commonly Used Medications In addition to the commonly used classes discussed above, there are other less commonly used medications that can work well for some people: Alpha glucosidase inhibitors Bile acid sequestrants Dopamine-2 agonists Meglitinides Alpha-Glucosidase Inhibitors Acarbose Precose and miglitol Glyset are alpha-glucosidase inhibitors.
Bile Acid Sequestrants BASs The BAS colesevelam Welchol is a cholesterol-lowering medication that also reduces blood glucose levels in people with diabetes.
Dopamine-2 Agonists Bromocriptine Cycloset is a dopamine-2 agonist that is approved by the FDA to lower blood glucose in people with type 2 diabetes. Meglitinides Meglitinides are drugs that also stimulate beta cells to release insulin. Combination Therapy Because the drugs listed above act in different ways to lower blood glucose levels, they may be used together to help meet your individualized diabetes goals.
: Anti-diabetic medications| Continuing Education Activity | Often, patients and physicians are reluctant to intensify therapy due to the fear of hypoglycemia, regimen complexity, and increased multiple daily injections. Such approaches play a vital role in preventing or delaying the onset and progression of diabetic complications. Curr Diab Rep 13 3 — Main article: Gliflozin. If this trend continues, it is projected that in one in three Americans will have diabetes. SE: hypoglycemia Safe for elderly Duration of action is only 4 hours Take within minutes of meal. Kavitha Ganesan ; Muhammad Burhan Majeed Rana ; Senan Sultan. |
| Self-assessment Quiz | Furthermore, it improves insulin sensitivity by activating insulin receptor expression and enhancing tyrosine kinase activity. Medically reviewed by Dominique Fontaine, BSN, RN, HNB-BC, HWNC-BC. Effect of hemoglobin A1c reduction or weight reduction on blood pressure in glucagon-like peptide-1receptor agonist and sodium-glucose cotransporter-2 inhibitor treatment in type 2 diabetes mellitus: A meta-analysis. Accessed Sept. It is considered an integral part in the prevention and management of both prediabetes and diabetes. JAMA 17 —9. Acarbose Precose® various generics. |
| Discover more about Type 2 Diabetes | In the Action to Control Cardiovascular Risk in Diabetes trial, aggressive treatment of T2DM patients with higher CV risk was associated with higher all-cause and CV mortality. Post hoc analyses could not find correlation with faster rates of reduction of glucose, hypoglycemia, or specific drugs as the causes underlying this finding. Exposure to injected insulin was hypothesized to increase CV mortality. However, after adjustment for baseline covariates, no significant association of insulin dose with CV death remained Older patients with cognitive dysfunction may not benefit from intensive therapy. Furthermore, hypoglycemia in the elderly may cause cardiac ischemia, arrhythmia, myocardial infarction, and sudden death Sulfonylureas lower blood glucose level by increasing insulin secretion in the pancreas by blocking the K ATP channels. They also limit gluconeogenesis in the liver. Sulfonylureas decrease breakdown of lipids to fatty acids and reduce clearance of insulin in the liver Sulfonylureas are currently prescribed as second-line or add-on treatment options for management of T2DM. They are divided into two groups: first-generation agents, which includes chlorpropamide, tolazamide, and tolbutamide, and second-generation agents, which includes glipizide, glimepiride, and glyburide. The first-generation sulfonylureas are known to have longer half-lives, higher risk of hypoglycemia, and slower onset of action, as compared to second-generation sulfonylureas. Currently, in clinical practice, second-generation sulfonylureas are prescribed and more preferred over first-generation agents because they are proven to be more potent given to patients at lower doses with less frequency , with the safest profile being that of glimepiride. Hypoglycemia is the major side effect of all sulfonylureas, while minor side effects such as headache, dizziness, nausea, hypersensitivity reactions, and weight gain are also common. Sulfonylureas are contraindicated in patients with hepatic and renal diseases and are also contraindicated in pregnant patients due to the possible prolonged hypoglycemic effect to infants. Drugs that can prolong the effect of sulfonylureas such as aspirin, allopurinol, sulfonamides, and fibrates must be used with caution to avoid hypoglycemia. Moreover, other oral antidiabetic medications or insulin can be used in combination with sulfonylurea and can substantially increase the risk of hypoglycemia. Patients on beta-adrenergic antagonists for the management of hypertension can have hypoglycemia unawareness. Sulfonylureas should be used with caution in subjects receiving beta blockers. Meglitinides repaglinide and nateglinide are non-sulfonylurea secretagogues, which was approved as treatment for T2DM in Meglitinide shares the same mechanism as that of sulfonylureas; it also binds to the sulfonylurea receptor in β-cells of the pancreas. However, the binding of meglitinide to the receptor is weaker than sulfonylurea, and thus considered short-acting insulin secretagogues, which gives flexibility in its administration. Rapid-acting secretagogues meglitinides may be used in lieu of sulfonylureas in patients with irregular meal schedules or those who develop late postprandial hypoglycemia while using a sulfonylurea. Like biguanides, TZDs improve insulin action. Rosiglitazone and pioglitazone are representative agents. TZDs are agonists of PPAR and facilitate increased glucose uptake in numerous tissues including adipose, muscle, and liver. Mechanisms of action include diminution of free fatty acid accumulation, reduction in inflammatory cytokines, rising adiponectin levels, and preservation of β-cell integrity and function, all leading to improvement of insulin resistance and β-cell exhaustion. However, there are high concerns of risks overcoming the benefits. Namely, combined insulin-TZD therapy causes heart failure. Thus, TZDs are not preferred as first-line or even step-up therapy. Pramlintide, an amylin analog, is an agent that delays gastric emptying, blunts pancreatic secretion of glucagon, and enhances satiety. It is a Food and Drug Administration FDA -approved therapy for use in adults with T1DM. Pramlintide induces weight loss and lowers insulin dose. Concurrent reduction of prandial insulin dosing is required to reduce the risk of severe hypoglycemia. Other medications that may lower blood sugar include bromocriptine, alpha-glucosidase inhibitors like voglibose and acarbose, and bile acid sequestrants like colesevelam. It may be noted that metformin sequesters bile acids in intestinal lumen and thus has a lipid-lowering effect, also the same mechanism may contribute to gas production and gastrointestinal disturbances. Important components of the Standards of Medical Care in Diabetes involves taking care of complications of diabetes and comorbidities including hypertension, atherosclerotic cardiovascular disease ASCVD , dyslipidemia, hypercoagulopathy, endothelial cell dysfunction, nephropathy, and retinopathy. CVD is the most important cause of morbidity and mortality in patients with diabetes. Angiotensin-converting enzyme inhibitors or angiotensin receptor blockers are the preferred antihypertensive medication 2. Optimal blood pressure and blood glucose control can effectively delay the progression of nephropathy and retinopathy in these patients. Patients with existing CVD should be continuously managed with aspirin, including providing primary prevention in subjects less than 50 years old. Self-monitoring of blood glucose and HbA1C are integral components of the standards of care in diabetes. SMBG allows patients to assess their own response to medication, minimize the risk of hypoglycemia, and determine whether they are achieving glycemic control. However, testing six to eight times daily may burden patients and may result in non-compliance. Therefore, it is recommended to ensure that patients are properly instructed and are given regular evaluation and follow-up. Self-monitoring of blood glucose is essential in patients with diabetes who are on intense insulin regimen three to four injections of basal and prandial or insulin pump. It monitors and prevents hyperglycemia and possible side effect of hypoglycemia. Blood glucose level is usually checked prior to meals, prior to exercise, prior to driving, and at bedtime. Evidence is insufficient to prescribe SMBG for patients not receiving an intensive insulin regimen According to the current guideline, HbA1C level should be assessed regularly in all patients with diabetes. HbA1C testing is performed at least every 6 months for patients who are meeting treatment goals; for patients who are far from their glycemic goals, HbA1C testing may be performed more frequently. Type 2 diabetes mellitus is one of the leading causes of renal failure, ASCVD, non-traumatic lower limb amputation, blindness, and death worldwide. It is a serious chronic medical condition that requires a multidisciplinary team approach, consisting of healthcare professionals, dietitians, patient educators, patients, and their families. Lifestyle intervention designed to manage body weight and treat obesity, as well as patient education, are essential for all patients with diabetes. Effectiveness of therapy must be evaluated as frequent as possible using diagnostic blood tests HbA1C , as well as monitoring for development of diabetic complications e. Furthermore, aggressive efforts from physicians and motivating patients for compliance are the two important aspects of the prevention and management of diabetes. Sociocultural issues should be carefully considered. For example, during religious fasting e. Primary prevention of T2DM should be an urgent public health policy. The disease predominantly affects working-age people and therefore has a counterproductive economic impact, compounded by the frequent occurrence and interaction of T2DM with infectious diseases such as AIDS and tuberculosis Evidence from landmark T2DM prevention trials indicates that lifestyle modification is more effective, cheaper, and safer than medication and provides sustained benefits. Lifestyle modification may be promising approach to T2DM prevention in developing countries. This will be useful for many ethnic groups in the U. as well, such as South Asian, Latino, Pima Indians, and African-American populations, which may face socioeconomic challenges similar to what is seen in developing countries. T2DM pathophysiology is increasingly understood as a mix of insulin resistance and secretory defects of β-cells Several options for pharmacologic therapy of lowering blood glucose are currently available, which have revolutionized long-term management of DM Several antidiabetic drugs may have important CV complications, which the provider team should always be aware The polypharmacy issues, management of diabetes, as well as hypertension, hyperlipidemia, and use of aspirin should be carefully explained to patients to ensure adherence to therapy to prevent significant CV morbidity and mortality. Careful attention should be paid to development of insulinopenic states by clinical assessment of C peptide and lack of control of HbA1C with multiple medications, and complete lack of secreted insulin conditions should be treated by initiation of appropriate insulin regimens. Every clinical encounter should also be utilized to explain the benefit of weight loss and motivated for such. Even though not yet conclusive, clinical trial and data support consideration of bariatric surgery as a possible strategy to monitor blood glucose levels and body weight, especially in morbid obesity Balanced hypocaloric diets that cause weight loss must be adopted, and regular interactions with dietitian is a useful approach. Behavioral strategies for weight loss should be encouraged in primary care settings and appropriate maintenance of body weight prior to conception may help after development of gestational diabetes. Weight loss may be particularly challenging for incapacitated patients and subjects with disabilities, so comprehensive approaches should be undertaken. Newer molecular studies have demonstrated the transcriptional link between inflammatory pathways and increased adipose tissue storage, contributing to insulin resistance Drug repurposing of the anti-inflammatory agent for aphthous stomatitis, amlexanox, is currently undergoing trials as newer agents for management of diabetes AC conceptualized and led project and drafted manuscript. CD checked accuracy of clinical contents and provided numerous clinical pearls. VSRD checked accuracy of clinical contents and numerous clinical discussions. SK contributed to numerous clinical pearls and revisions. AC contributed to important clinical discussions and revisions. RR contributed to important clinical discussions and revisions. AM contributed to important clinical contribution, especially management with coexistent chronic diseases. NSS contributed to clinical concepts and numerous clinical discussions. MTM prepared initial outline of some aspects of the manuscript. KK contributed to numerous clinical discussions. AS contributed to clinical discussions. AB checked grammar and formatted the initial table. NP contributed to initial discussions. CKM checked accuracy of clinical contents. GPL contributed to important clinical contents and numerous clinical guidance. WM contributed to overall senior mentorship and guidance and support to project. The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest. Internal Clinical Guidelines Team. Type 2 Diabetes in Adults: Management. London: National Institute for Health and Care Excellence Google Scholar. Standards of medical care in diabetes summary of revisions. Diabetes Care 39 Suppl 1 :S4—5. CrossRef Full Text Google Scholar. American Diabetes Association. Standards of medical care in diabetes. Diabetes Care 37 1 — Kalra S, Agrawal N. Diabetes and HIV: current understanding and future perspectives. Curr Diab Rep 13 3 — PubMed Abstract CrossRef Full Text Google Scholar. Sukhija R, Prayaga S, Marashdeh M, Bursac Z, Kakar P, Bansal D, et al. Effect of statins on fasting plasma glucose in diabetic and nondiabetic patients. J Investig Med 57 3 —9. Mancia G. Preventing new-onset diabetes in thiazide-treated patients. Lancet Diabetes Endocrinol 4 2 —2. Santos-Longhurst A, Krucik G. Type 2 Diabetes Statistics and Facts. Healthline Available from: www. Centers for Disease Control and Prevention. Diabetes Latest. National Diabetes Statistics Report: Statistics about Diabetes. Fast Facts-Data and Statistics about Diabetes. DiabetesPro Nyenwe EA, Kitabchi AE. The evolution of diabetic ketoacidosis: an update of its etiology, pathogenesis and management. Metabolism 65 4 — Stratton IM, Adler AI, Neil HA, Matthews DR, Manley SE, Cull CA, et al. Association of glycaemia with macrovascular and microvascular complications of type 2 diabetes UKPDS 35 : prospective observational study. BMJ — Stoppler M, Shiel W. Hemoglobin A1C Test. EMedicine health. Dansinger M. The Hemoglobin A1C Test for Diabetes. WebMD For People of African, Mediterranean, or Southeast Asian Heritage: Important Information about Diabetes Blood Tests. National Institute of Diabetes and Digestive and Kidney Diseases Screening for Type 2 Diabetes. Clinical Diabetes Tabak A, Herder C, Rathmann W, Brunner E, Kivimaki M. Prediabetes: a high risk state for developing diabetes. Lancet — Tuso P. Prediabetes and lifestyle modification: time to prevent a preventable disease. Perm J 18 3 — Consumption of Carbohydrate in People with Diabetes. Diabetes UK. Riccardi G, Rivellese A. Effects of dietary fiber and carbohydrate on glucose and lipoprotein metabolism in diabetic patients. Diabetes Care 14 12 — Umpierre D, Ribeiro PA, Kramer CK, Leitão CB, Zucatti AT, Azevedo MJ, et al. Physical activity advice only or structured exercise training and association with HbA1c levels in type 2 diabetes: a systematic review and meta-analysis. JAMA 17 —9. Pietraszek A, Gregersen S, Hermansen K. Alcohol and type 2 diabetes. A review. Nutr Metab Cardiovasc Dis 20 5 — Defronzo RA. Banting Lecture. From the triumvirate to the ominous octet: a new paradigm for the treatment of type 2 diabetes mellitus. Diabetes 58 4 — Bailey CJ. The current drug treatment landscape for diabetes and perspectives for the future. Clin Pharmacol Ther 98 2 — James JC, Andrew SR, Charles FS Jr, Annie N. PA-C diagnosis and management of diabetes: synopsis of the ; American Diabetes Association standards of medical care in diabetes. Ann Intern Med — Nathan DM, Buse JB, Davidson MB, Ferrannini E, Holman RR, Sherwin R, et al. Medical management of hyperglycemia in type 2 diabetes: a consensus algorithm for the initiation and adjustment of therapy: a consensus statement of the American Diabetes Association and the European Association for the Study of Diabetes. Diabetes Care 32 1 Inzucchi SE, Bergenstal RM, Buse JB, Diamant M, Ferrannini E, Nauck M, et al. Management of hyperglycemia in type 2 diabetes, a patient-centered approach: update to a position statement of the American Diabetes Association and the European Association for the Study of Diabetes. Diabetes Care 38 1 —9. Palmer SC, Mavridis D, Nicolucci A, Johnson DW, Tonelli M, Craig JC, et al. Comparison of clinical outcomes and adverse events associated with glucose-lowering drugs in patients with type 2 diabetes: a meta-analysis. JAMA 3 — Viollet B, Guigas B, Garcia N, Leclerc J, Foretz M, Andreelli F. Cellular and molecular mechanisms of metfromin: an overview. Clin Sci Lond 6 — Inzucchi SE, Lipska KJ, Mayo H, Bailey CJ, McGuire DK. Metformin in patients with type 2 diabetes and kidney disease: a systematic review. JAMA 24 — Fogelman Y, Kitai E, Blumberg G, Golan-Cohen A, Rapoport M, Carmeli E. Vitamin B12 screening in metformin-treated diabetics in primary care: were elderly patients less likely to be tested? Aging Clin Exp Res Nathan DM, Buse JB, Kahn SE, Krause-Steinrauf H, Larkin ME, Staten M, et al. Rationale and design of the glycemia reduction approaches in diabetes: a comparativeeffectiveness study GRADE. Diabetes Care 36 8 — Nauck MA, Meier JJ. The incretin effect in healthy individuals and those with type 2 diabetes: physiology, pathophysiology, and response to therapeutic interventions. Lancet Diabetes Endocrinol 4 6 — Maruthur NM, Tseng E, Hutfless S, Wilson LM, Suarez-Cuervo C, Berger Z, et al. Diabetes medications as monotherapy or metformin-based combination therapy for type 2 diabetes: a systematic review and meta-analysis. Ann Intern Med 11 — Harris KB, McCarty DJ. Efficacy and tolerability of glucagon-like peptide-1 receptor agonists in patients with type 2 diabetes mellitus. Ther Adv Endocrinol Metab 6 1 :3— Riser Taylor S, Harris KB. The clinical efficacy and safety of sodium glucose cotransporter-2 inhibitors in adults with type 2diabetes mellitus. Pharmacotherapy 33 9 — UK Prospective Diabetes Study UKPDS Group. Effect of intensive blood-glucose control with metformin on complications in overweight patients with type 2 diabetes UKPDS Lancet —65; Erratum in: Lancet Siraj ES, Rubin DJ, Riddle MC, Miller ME, Hsu FC, Ismail-Beigi F, et al. Insulin dose and cardiovascular mortality in the ACCORD trial. Diabetes Care 38 11 —8. Ismail-Beigi F. Pathogenesis and glycemic management of type 2 diabetes mellitus: a physiological approach. Arch Iran Med 15 4 — PubMed Abstract Google Scholar. Proks P, Reimann F, Green N, Gribble F, Ashcroft F. Sulfonylurea stimulation of insulin secretion. 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Eur Heart J 36 34 — Lifestyle choices, including eating a healthy diet, exercising and staying at a healthy weight, are key to managing type 2 diabetes. But you also might need to take medication to keep your blood sugar, also called glucose, at a healthy level. Sometimes one medication is enough. In other cases, taking several medications works better. The list of medications for type 2 diabetes is long and can be confusing. Take time to learn about these medicines — how they're taken, what they do and what side effects they may cause. That can help you get ready to talk to your health care provider about diabetes treatment choices that are right for you. Several classes of type 2 diabetes medicines exist. Each class of medicine works in a different way to lower blood sugar. A medication may work by:. Each class of medicine has one or more medications. Some of these medications are taken by mouth, while others must be taken as a shot. Below is a list of common diabetes medications. Other medications are available too. Ask your health care provider about your choices and the pros and cons of each. People with liver problems or a history of heart failure shouldn't take this kind of diabetes medicine. No one diabetes treatment is best for everyone. What works for one person may not work for another. Your health care provider can explain how one medication or multiple medications may fit into your diabetes treatment plan. Sometimes combining medicines may increase the effectiveness of each individual medicine to lower blood sugar. Talk to your provider about the pros and cons of specific diabetes medications for you. There is a problem with information submitted for this request. Sign up for free and stay up to date on research advancements, health tips, current health topics, and expertise on managing health. Click here for an email preview. Error Email field is required. Error Include a valid email address. 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This content does not have an Arabic version. Appointments at Mayo Clinic Mayo Clinic offers appointments in Arizona, Florida and Minnesota and at Mayo Clinic Health System locations. Request Appointment. Diabetes treatment: Medications for type 2 diabetes. Products and services. Diabetes treatment: Medications for type 2 diabetes By Mayo Clinic Staff. Thank you for subscribing! Sorry something went wrong with your subscription Please, try again in a couple of minutes Retry. Show references Papadakis MA, et al. Diabetes mellitus and hypoglycemia. McGraw-Hill; Accessed Sept. Wexler DJ. Overview of general medical care in nonpregnant adults with diabetes mellitus. Oral medication: What are my options? American Diabetes Association. Sulfonylureas and meglitinides in the treatment of diabetes mellitus. |
Anti-diabetic medications -
However, in after its standardization, the International Expert Committee recommended it to be used in diagnosing T2DM but not in T1DM and gestational diabetes 2. HbA1C level is reported in percentages, and a normal level is below 5. The main advantage of the HbA1C test over other blood glucose tests is the convenience it offers to patients; it does not require fasting and can be done at any time of the day.
However, this test is more expensive and may not be readily available in certain locations, which may limit its usefulness 14 , HbA1C may be inaccurate in conditions such as anemia, hemolysis, and other hemoglobinopathies like sickle cell disease and hemoglobin Hb variants like HbC, HbE, and HbD, as well as elevated fetal hemoglobin.
Thus, HbA1C assay in people of South Asian, Mediterranean, or African origin merit taking these issues into account In conditions associated with increased RBC breakdown, such as in the advanced trimesters of pregnancy, recent hemorrhage, intravascular hemolysis or transfusion or erythropoietin treatment, only blood glucose estimation should be used to diagnose diabetes.
There are limited data supporting the use of A1C in diagnosing T2DM in children and adolescents. Although A1C is not routinely suggested for diagnosis of diabetes in children with cystic fibrosis or symptoms that portend development of acute onset of T1DM, the ADA recommends HbA1C for diagnosis of T2DM in children and adolescents.
In situations where there are two different tests with conflicting results, the test which is positive should be repeated and a diagnosis of diabetes is made after a confirmatory test has been done 2. It is also important to note that prediabetes may be associated with obesity, dyslipidemia, and hypertension; therefore, lifestyle changes such as healthy diet, physical activity, and cessation of smoking, in addition to the introduction of pharmacological agents, are deemed important to stop or delay the timeline of development of diabetes.
This will enable the healthcare providers to optimally manage patients with either prediabetes or diabetes. The cornerstones of diabetes management include lifestyle intervention along with pharmacological therapy and routine blood glucose monitoring.
It is highly recommended by the ADA that patients with IGT, IFG or HbA1C level of 5. On the other hand, for patients who are already diagnosed with diabetes, nutrition advice provided by a registered dietitian is recommended. Weight loss can be achieved through a healthy balanced diet, with control of total calories and free carbohydrates.
However, for patients with diabetes adhering to a low carbohydrate diet, they should be informed on possible side effects such as hypoglycemia, headache and constipation Other studies have suggested consumption of complex dietary fiber and whole grains to improve glycemic control 2 , Studies show that exercise can improve glycemic control lower HbA1C level by 0.
It is considered an integral part in the prevention and management of both prediabetes and diabetes. According to the U. Consumption of alcohol, especially in a fasted state, can precipitate life-threatening hypoglycemia and coma and should be explicitly counseled to patients during their visits Moreover, patient education, counseling, and psychosocial support are very important to successfully combat the deleterious effects of diabetes.
These include i reduced insulin secretion from pancreatic β-cells, ii elevated glucagon secretion from pancreatic α cells, iii increased production of glucose in liver, iv neurotransmitter dysfunction and insulin resistance in the brain, v enhanced lipolysis, vi increased renal glucose reabsorption, vii reduced incretin effect in the small intestine, and viii impaired or diminished glucose uptake in peripheral tissues such as skeletal muscle, liver, and adipose tissue.
Currently available glucose-lowering therapies target one or more of these key pathways. Good glycemic control remains the main foundation of managing T2DM.
Such approaches play a vital role in preventing or delaying the onset and progression of diabetic complications. It is important that a patient-centered approach should be used to guide the choice of pharmacological agents.
The factors to be considered include efficacy, cost, potential side effects, weight gain, comorbidities, hypoglycemia risk, and patient preferences. Pharmacological treatment of T2DM should be initiated when glycemic control is not achieved or if HbA1C rises to 6.
Not delaying treatment and motivating patients to initiate pharmacotherapy can considerably prevent the risk of the irreversible microvascular complications such as retinopathy and glomerular damage Monotherapy with an oral medication should be started concomitantly with intensive lifestyle management.
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.
If the HbA1C level rises to 7. Though these medications may be used in all patients irrespective of their body weight, some medications like liraglutide may have distinct advantages in obese patients in comparison to lean diabetics see below.
A schematic of currently approved medications for T2DM is summarized in Table 1. A flowchart for guiding clinical decision making is presented in Figure 1. Figure 1. Medications in green, causes weight loss; in red, causes weight gain.
The discovery of biguanide and its derivatives for the management of diabetes started in the middle ages. Galega officinalis , a herbaceous plant, was found to contain guanidine, galegine, and biguanide, which decreased blood glucose levels Metformin is a biguanide that is the main first-line oral drug of choice in the management of T2DM across all age groups.
Metformin activates adenosine monophosphate-activated protein kinase in the liver, causing hepatic uptake of glucose and inhibiting gluconeogenesis through complex effects on the mitochondrial enzymes Metformin is highly tolerated and has only mild side effects, low risk of hypoglycemia and low chances of weight gain.
Metformin is shown to delay the progression of T2DM, reduce the risk of complications, and reduce mortality rates in patients by decreasing hepatic glucose synthesis gluconeogenesis and sensitizing peripheral tissues to insulin Furthermore, it improves insulin sensitivity by activating insulin receptor expression and enhancing tyrosine kinase activity.
Recent evidence also suggest that metformin lowers plasma lipid levels through a peroxisome proliferator-activated receptor PPAR -α pathway, which prevents CVDs Reduction of food intake possibly occurs by glucagon-like peptide-1 GLP-1 -mediated incretin-like actions.
Metformin may thus induce modest weight loss in overweight and obese individuals at risk for diabetes. Once ingested, metformin with a half-life of approximately 5 h is absorbed by organic cation transporters and remains unmetabolized in the body and is widely distributed into different tissues such as intestine, liver, and kidney.
The primary route of elimination is via kidney. If metformin is used when GFR is significantly diminished, the dose should be reduced and patients should be advised to discontinue the medication if nausea, vomiting, and dehydration arises from any other cause to prevent ketoacidosis.
It is important to assess renal function prior to starting this medication. Introduction of metformin at low doses often improve tolerance. Extended release preparations seldom cause any gastrointestinal issues. Very rarely, metformin may cause lactic acidosis, mainly in subjects with severe renal insufficiency.
Metformin is highly efficient when there is enough insulin production; however, when diabetes reaches the state of failure of β-cells and resulting in a type 1 phenotype, metformin loses its efficacy.
Metformin can cause vitamin B12 and folic acid deficiency This needs to be monitored, especially in elderly patients. Though very rare, in patients with metformin intolerance or contraindications, an initial drug from other oral classes may be used.
Although trials have compared dual therapy with metformin alone, few directly compare drugs as add-on therapy. A comparative effectiveness meta-analysis suggests that overall each new class of non-insulin medications introduced in addition to the initial therapy lowers A1C around 0.
An ongoing Glycemia Reduction Approaches in Diabetes: A Comparative Effectiveness Study GRADE has compared the effect of four major drug classes sulfonylurea, DPP-4 inhibitor, GLP-1 analog, and basal insulin over 4 years on glycemic control and other psychosocial, medical, and health economic outcomes Though it will be a welcome development for introduction of oral agents for metformin for gestational diabetes, current FDA regulations do not support it.
Incretin effect is the difference in insulin secretory response from an oral glucose load in comparison to glucose administered intravenously. The two naturally occurring incretin hormones that play important roles in the maintenance of glycemic control: glucose-dependent insulinotropic polypeptide GIP, or incretin and glucagon-like peptide GLP-1 ; these peptides have a short half-life, as these are rapidly hydrolyzed by DPP-4 inhibitors within 1½ min.
In patients with T2DM, the incretin effect is reduced or absent. In particular, the insulinotropic action of GIP is lost in patients with T2DM. Incretins decrease gastric emptying and causes weight loss. Because of impact on weight loss, these medications may find increasing use in diabesity.
Targeting the incretin system has become an important therapeutic approach for treating T2DM. These two drug classes include GLP-1 receptor agonists and DPP-4 inhibitors. Clinical data have revealed that these therapies improve glycemic control while reducing body weight specifically, GLP-1 receptor agonists and systolic blood pressure in patients with T2DM Furthermore, hypoglycemia is low except when used in combination with a sulfonylurea because of their glucose-dependent mechanism of action.
The currently GLP-1 receptor agonists available are exenatide and liraglutide. These drugs exhibit increased resistance to enzymatic degradation by DPP4.
In young patients with recent diagnosis of T2DM, central obesity, and abnormal metabolic profile, one should consider treatment with GLP-1 analogs that would have a beneficial effect on weight loss and improve the metabolic dysfunction.
GLP-1 analogs are contraindicated in renal failure. Because of its half-life of 2. Exenatide is generally well tolerated, with mild-to-moderate gastrointestinal effects being the most common adverse effect.
Liraglutide has a long duration of action 24 h. Liraglutide causes 1. Liraglutide is well tolerated, with only nausea and minor hypoglycemia risk increased with use of sulfonylureas. Serum antibody formation was very low in patients treated with once-weekly GLP-1 receptor agonists.
The formation of these antibodies did not decrease efficacy of their actions on blood glucose lowering. Dipeptidyl peptidase 4 inhibitors include sitagliptin, saxagliptin, vidagliptin, linagliptin, and alogliptin. These medications may be used as single therapy, or in addition with metformin, sulfonylurea, or TZD.
This treatment is similar to the other oral antidiabetic drugs. The gliptins have not been reported to cause higher incidence of hypoglycemic events compared with controls. Dipeptidyl peptidase 4 inhibitors impact postprandial lipid levels.
Treatment with vidagliptin for 4 weeks decreases postprandial plasma triglyceride and apolipoprotein Bcontaining triglyceride-rich lipoprotein particle metabolism after a fat-rich meal in T2DM patients who have previously not been exposed to these medications.
In diabetic patients with coronary heart disease, it was demonstrated that treatment with sitagliptin improved cardiac function and coronary artery perfusion. The three most commonly reported adverse reactions in clinical trials with gliptins were nasopharyngitis, upper respiratory tract infection, and headache.
Acute pancreatitis was reported in a fraction of subjects taking sitagliptin or metformin and sitagliptin. An increased incidence of hypoglycemia was observed in the sulfonylurea treatment group. In the elderly, DPP-4 inhibitors lower blood glucose but have minimal effect on caloric intake and therefore less catabolic effect on muscle and total body protein mass.
In decreased doses, DPP-4 inhibitors are considered safe in patients with moderate to severe renal failure. Sodium-glucose cotransporter inhibitors are new classes of glucosuric agents: canagliflozin, dapagliflozin, and empagliflozin. SGLT2 inhibitors provide insulin-independent glucose lowering by blocking glucose reabsorption in the proximal renal tubule by inhibiting SGLT2 Because of glucose-independent mechanism of action, these drugs may be effective in advanced stages of T2DM when pancreatic β-cell reserves are permanently lost.
These drugs provide modest weight loss and blood pressure reduction. Urinary tract infections leading to urosepsis and pyelonephritis, as well as genital mycosis, may occur with SGLT2 inhibitors. SGLT2 inhibitors may rarely cause ketoacidosis.
Patients should stop taking their SGLT2 inhibitor and seek medical attention immediately if they have symptoms of ketoacidosis frank nausea or vomiting, or even non-specific features like tiredness or abdominal discomfort.
If non-insulin monotherapy like metformin at the maximum tolerated dose does not achieve or maintain the A1C target over 3 months, then a second oral agent may be added to the regimen, a GLP-1 receptor agonist, or basal insulin.
The clinical picture of T2DM and its therapies should be regularly and objectively elaborated to patients. Many subjects with T2DM shall require insulin therapy sometime during the course of the disease.
For patients with T2DM with inadequate target glycemic goals, insulin therapy should not be postponed. Providers should advocate insulin as a therapy in a complete non-judgmental, empathetic, and non-punitive approach to ensure superior quality of adherence.
Self-monitoring of blood glucose SMBG discussed below contributes to significant improvement of glycemic control in patients with T2DM initiating insulin. Close and frequent monitoring of the patient is needed for any dose titration to achieve target glycemic goals, as well as to prevent hypoglycemia.
Basal insulin is the initial insulin regimen, beginning at 10 U or 0. Use of basal insulin greater than 0. Basal insulin is usually added to oral metformin and possibly one additional non-insulin agent like DPP-4 or SGLT-2 inhibitor. NPH neutral protamine Hagedorn insulin carries low risk of hypoglycemia in individuals without any significant past history, and is low cost.
Newer, longer acting, basal insulin analogs have superior pharmacodynamic profiles, delayed onset and longer duration of action but low risk of hypoglycemia, albeit at higher costs. Concentrated basal insulin preparations such as U regular is five times more potent per volume of insulin i.
U glargine and U degludec are other potent, ultra-long acting preparations. If basal insulin contributes to acceptable fasting blood glucose, but A1C persistently remains above target, mealtime insulin may be added. Rapid-acting insulin analog lispro, aspart, or glulisine may be used and administered just before meals.
The glucose levels should be monitored before meals and after the injections. The total present insulin dose may be computed and then one-half of this amount may be administered as basal and the other half during mealtime, the latter split equally between three meals.
Sometime, bolus insulin needs to be administered in addition to basal insulin. Rapid-acting analogs are used as bolus formulations due to their prompt onset of action.
Insulin pump continuous subcutaneous insulin infusion may be used instead to avoid multiple injections. Often, patients and physicians are reluctant to intensify therapy due to the fear of hypoglycemia, regimen complexity, and increased multiple daily injections. There is a need for a flexible, alternative intensification option taking into account individual patient considerations to achieve or maintain individual glycemic targets.
An ideal insulin regimen should mimic physiological insulin release while providing optimal glycemic control with low risk of hypoglycemia, weight gain, and fewer daily injections.
Inhaled insulin Technosphere insulin-inhalation system, Afrezza is now available for prandial use. However, the dosing range is limited. Use of inhaled insulin requires pulmonary function testing prior to and after starting therapy.
It is contraindicated in subjects with asthma or other lung diseases. During insulin therapy, sulfonylureas, DPP-4 inhibitors, and GLP-1 receptor agonists are stopped once more complex insulin regimens beyond basal insulin are used.
In patients with inadequate blood glucose control, especially if requiring escalating insulin doses, TZDs usually pioglitazone or SGLT2 inhibitors may be added as adjunctive therapy to insulin. Insulin injections can cause weight gain or loss.
Insulin drives potassium into the cell and can cause hypokalemia. Components of the insulin preparation have the potential to cause allergy.
Insulin injections, along with the use of other drugs like TZDs, can precipitate cardiac failure. Stressful events like illness, surgery, and trauma can impede glycemic control and may lead to development of DKA or non-ketotic hyperosmolar state, life-threatening conditions, which merits immediate medical attention.
Any condition that deteriorates glycemic control necessitates more frequent monitoring of blood glucose in an inpatient setting; ketosis-prone patients also require urine or blood ketone monitoring.
If accompanied by ketosis, vomiting, or altered mental status, marked hyperglycemia requires hospital admission. The patient treated with non-insulin therapies or medical nutrition therapy alone may require insulin. Patient must be aggressively hydrated and infections should be controlled.
Without adequate treatment, prolonged hyperglycemia can cause glucose toxicity that can progressively impair insulin secretion. Initiation of insulin therapy is critical to reverse the toxic effect of high blood glucose levels on the pancreas. Once persistent glycemic control is achieved, insulin can be tapered off and replaced with oral medications.
At some point in the management of T2DM, β-cell reserves are exhausted, with phenotypic reversal to a T1DM kind of pathophysiological situation.
Meticulous follow-up may identify such states and then the need for continued reliance on insulin therapy may be carefully explained to the patients. Weight gain can raise a barrier to the use of insulin in T2DM. In the United Kingdom Prospective Diabetes Study UKPDS study, patients gained 6 kg with insulin therapy, when compared with 1.
More recently, the combination of GLP-1 receptor agonists and insulin has been useful in tackling the weight gain associated with insulin and circumventing the need for high doses in the presence of significant insulin resistance. Lipoatrophy with insulin injections is not seen now; however, lipohypertrophy due to failure to change the subcutaneous injection sites is still a common cause of poor insulin absorption and suboptimal glycemic control.
In the Action to Control Cardiovascular Risk in Diabetes trial, aggressive treatment of T2DM patients with higher CV risk was associated with higher all-cause and CV mortality.
Post hoc analyses could not find correlation with faster rates of reduction of glucose, hypoglycemia, or specific drugs as the causes underlying this finding. Exposure to injected insulin was hypothesized to increase CV mortality. However, after adjustment for baseline covariates, no significant association of insulin dose with CV death remained Older patients with cognitive dysfunction may not benefit from intensive therapy.
Furthermore, hypoglycemia in the elderly may cause cardiac ischemia, arrhythmia, myocardial infarction, and sudden death Sulfonylureas lower blood glucose level by increasing insulin secretion in the pancreas by blocking the K ATP channels.
They also limit gluconeogenesis in the liver. Sulfonylureas decrease breakdown of lipids to fatty acids and reduce clearance of insulin in the liver Sulfonylureas are currently prescribed as second-line or add-on treatment options for management of T2DM.
They are divided into two groups: first-generation agents, which includes chlorpropamide, tolazamide, and tolbutamide, and second-generation agents, which includes glipizide, glimepiride, and glyburide. The first-generation sulfonylureas are known to have longer half-lives, higher risk of hypoglycemia, and slower onset of action, as compared to second-generation sulfonylureas.
Currently, in clinical practice, second-generation sulfonylureas are prescribed and more preferred over first-generation agents because they are proven to be more potent given to patients at lower doses with less frequency , with the safest profile being that of glimepiride. Hypoglycemia is the major side effect of all sulfonylureas, while minor side effects such as headache, dizziness, nausea, hypersensitivity reactions, and weight gain are also common.
Sulfonylureas are contraindicated in patients with hepatic and renal diseases and are also contraindicated in pregnant patients due to the possible prolonged hypoglycemic effect to infants.
Drugs that can prolong the effect of sulfonylureas such as aspirin, allopurinol, sulfonamides, and fibrates must be used with caution to avoid hypoglycemia.
Moreover, other oral antidiabetic medications or insulin can be used in combination with sulfonylurea and can substantially increase the risk of hypoglycemia.
Patients on beta-adrenergic antagonists for the management of hypertension can have hypoglycemia unawareness. Sulfonylureas should be used with caution in subjects receiving beta blockers.
Meglitinides repaglinide and nateglinide are non-sulfonylurea secretagogues, which was approved as treatment for T2DM in Meglitinide shares the same mechanism as that of sulfonylureas; it also binds to the sulfonylurea receptor in β-cells of the pancreas. However, the binding of meglitinide to the receptor is weaker than sulfonylurea, and thus considered short-acting insulin secretagogues, which gives flexibility in its administration.
Rapid-acting secretagogues meglitinides may be used in lieu of sulfonylureas in patients with irregular meal schedules or those who develop late postprandial hypoglycemia while using a sulfonylurea.
Like biguanides, TZDs improve insulin action. Rosiglitazone and pioglitazone are representative agents. TZDs are agonists of PPAR and facilitate increased glucose uptake in numerous tissues including adipose, muscle, and liver.
Mechanisms of action include diminution of free fatty acid accumulation, reduction in inflammatory cytokines, rising adiponectin levels, and preservation of β-cell integrity and function, all leading to improvement of insulin resistance and β-cell exhaustion. However, there are high concerns of risks overcoming the benefits.
Namely, combined insulin-TZD therapy causes heart failure. Thus, TZDs are not preferred as first-line or even step-up therapy. Pramlintide, an amylin analog, is an agent that delays gastric emptying, blunts pancreatic secretion of glucagon, and enhances satiety.
It is a Food and Drug Administration FDA -approved therapy for use in adults with T1DM. Pramlintide induces weight loss and lowers insulin dose. Concurrent reduction of prandial insulin dosing is required to reduce the risk of severe hypoglycemia.
Other medications that may lower blood sugar include bromocriptine, alpha-glucosidase inhibitors like voglibose and acarbose, and bile acid sequestrants like colesevelam. It may be noted that metformin sequesters bile acids in intestinal lumen and thus has a lipid-lowering effect, also the same mechanism may contribute to gas production and gastrointestinal disturbances.
Important components of the Standards of Medical Care in Diabetes involves taking care of complications of diabetes and comorbidities including hypertension, atherosclerotic cardiovascular disease ASCVD , dyslipidemia, hypercoagulopathy, endothelial cell dysfunction, nephropathy, and retinopathy.
CVD is the most important cause of morbidity and mortality in patients with diabetes. Angiotensin-converting enzyme inhibitors or angiotensin receptor blockers are the preferred antihypertensive medication 2. Optimal blood pressure and blood glucose control can effectively delay the progression of nephropathy and retinopathy in these patients.
Patients with existing CVD should be continuously managed with aspirin, including providing primary prevention in subjects less than 50 years old.
Self-monitoring of blood glucose and HbA1C are integral components of the standards of care in diabetes. SMBG allows patients to assess their own response to medication, minimize the risk of hypoglycemia, and determine whether they are achieving glycemic control.
However, testing six to eight times daily may burden patients and may result in non-compliance. Therefore, it is recommended to ensure that patients are properly instructed and are given regular evaluation and follow-up.
Self-monitoring of blood glucose is essential in patients with diabetes who are on intense insulin regimen three to four injections of basal and prandial or insulin pump.
It monitors and prevents hyperglycemia and possible side effect of hypoglycemia. Blood glucose level is usually checked prior to meals, prior to exercise, prior to driving, and at bedtime. Evidence is insufficient to prescribe SMBG for patients not receiving an intensive insulin regimen According to the current guideline, HbA1C level should be assessed regularly in all patients with diabetes.
HbA1C testing is performed at least every 6 months for patients who are meeting treatment goals; for patients who are far from their glycemic goals, HbA1C testing may be performed more frequently.
Type 2 diabetes mellitus is one of the leading causes of renal failure, ASCVD, non-traumatic lower limb amputation, blindness, and death worldwide. It is a serious chronic medical condition that requires a multidisciplinary team approach, consisting of healthcare professionals, dietitians, patient educators, patients, and their families.
Lifestyle intervention designed to manage body weight and treat obesity, as well as patient education, are essential for all patients with diabetes. Effectiveness of therapy must be evaluated as frequent as possible using diagnostic blood tests HbA1C , as well as monitoring for development of diabetic complications e.
Furthermore, aggressive efforts from physicians and motivating patients for compliance are the two important aspects of the prevention and management of diabetes. Sociocultural issues should be carefully considered. For example, during religious fasting e.
Primary prevention of T2DM should be an urgent public health policy. The disease predominantly affects working-age people and therefore has a counterproductive economic impact, compounded by the frequent occurrence and interaction of T2DM with infectious diseases such as AIDS and tuberculosis Evidence from landmark T2DM prevention trials indicates that lifestyle modification is more effective, cheaper, and safer than medication and provides sustained benefits.
Lifestyle modification may be promising approach to T2DM prevention in developing countries. This will be useful for many ethnic groups in the U. as well, such as South Asian, Latino, Pima Indians, and African-American populations, which may face socioeconomic challenges similar to what is seen in developing countries.
T2DM pathophysiology is increasingly understood as a mix of insulin resistance and secretory defects of β-cells Several options for pharmacologic therapy of lowering blood glucose are currently available, which have revolutionized long-term management of DM Several antidiabetic drugs may have important CV complications, which the provider team should always be aware The polypharmacy issues, management of diabetes, as well as hypertension, hyperlipidemia, and use of aspirin should be carefully explained to patients to ensure adherence to therapy to prevent significant CV morbidity and mortality.
Careful attention should be paid to development of insulinopenic states by clinical assessment of C peptide and lack of control of HbA1C with multiple medications, and complete lack of secreted insulin conditions should be treated by initiation of appropriate insulin regimens.
Every clinical encounter should also be utilized to explain the benefit of weight loss and motivated for such. Even though not yet conclusive, clinical trial and data support consideration of bariatric surgery as a possible strategy to monitor blood glucose levels and body weight, especially in morbid obesity Balanced hypocaloric diets that cause weight loss must be adopted, and regular interactions with dietitian is a useful approach.
Behavioral strategies for weight loss should be encouraged in primary care settings and appropriate maintenance of body weight prior to conception may help after development of gestational diabetes.
Weight loss may be particularly challenging for incapacitated patients and subjects with disabilities, so comprehensive approaches should be undertaken. Newer molecular studies have demonstrated the transcriptional link between inflammatory pathways and increased adipose tissue storage, contributing to insulin resistance Drug repurposing of the anti-inflammatory agent for aphthous stomatitis, amlexanox, is currently undergoing trials as newer agents for management of diabetes AC conceptualized and led project and drafted manuscript.
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Sorry something went wrong with your subscription Please, try again in a couple of minutes Retry. Show references Papadakis MA, et al. Diabetes mellitus and hypoglycemia. McGraw-Hill; Accessed Sept. Wexler DJ. Overview of general medical care in nonpregnant adults with diabetes mellitus.
Oral medication: What are my options? American Diabetes Association. Sulfonylureas and meglitinides in the treatment of diabetes mellitus. Melmed S, et al. Therapeutics of type 2 diabetes mellitus. In: Williams Textbook of Endocrinology.
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Medicqtions Anti-diabetic medications different types, or medicatioms, of medications that work in Anti-disbetic ways to Anti-diabetic medications blood meddications also Anti-diabetic medications as blood sugar levels. Wakefulness during pregnancy options are taken by mouth and others are injected. Some of the commonly used classes of non-insulin medications include:. Metformin Glucophage is classified as a biguanide medication and is the only available medication in this class. Metformin lowers blood glucose levels primarily by decreasing the amount of glucose produced by the liver.Anti-diabetic medications -
These drugs are generally taken one to two times a day before meals. All sulfonylurea drugs have similar effects on blood glucose levels, but they differ in side effects, how often they are taken, and interactions with other drugs.
The most common side effects with sulfonylureas are low blood glucose and weight gain. Rosiglitazone Avandia and pioglitazone Actos are in a group of drugs called thiazolidinediones.
These drugs help insulin work better in the muscle and fat and reduce glucose production in the liver. A benefit of TZDs is that they lower blood glucose without having a high risk for causing low blood glucose.
Both drugs in this class can increase the risk for heart failure in some individuals and can also cause fluid retention edema in the legs and feet. In addition to the commonly used classes discussed above, there are other less commonly used medications that can work well for some people:.
Acarbose Precose and miglitol Glyset are alpha-glucosidase inhibitors. These drugs help the body lower blood glucose levels by blocking the breakdown of starches, such as bread, potatoes, and pasta in the intestine. By slowing the breakdown of these foods, this slows the rise in blood glucose levels after a meal.
These medications should be taken with the first bite of each meal, so they need to be taken multiple times daily. Based on how these medications work, they commonly cause gastrointestinal side effects including gas and diarrhea. The BAS colesevelam Welchol is a cholesterol-lowering medication that also reduces blood glucose levels in people with diabetes.
BASs help remove cholesterol from the body, particularly LDL cholesterol, which is often elevated in people with diabetes. The medications reduce LDL cholesterol by binding with bile acids in the digestive system.
The body in turn uses cholesterol to replace the bile acids, which lowers cholesterol levels. The mechanism by which colesevelam lowers glucose levels is not well understood. Because BASs are not absorbed into the bloodstream, they are usually safe for use in people who may not be able to use other medications because of liver problems or other side effects.
Because of the way they work, side effects of BASs can include flatulence and constipation, and they can interact with the absorption of other medications taken at the same time.
Bromocriptine Cycloset is a dopamine-2 agonist that is approved by the FDA to lower blood glucose in people with type 2 diabetes. Bromocriptine is taken once daily in the morning. A common side effect is nausea. Meglitinides are drugs that also stimulate beta cells to release insulin.
Nateglinide Starlix and repaglinide Prandin are both meglitinides. They are taken before each meal to help lower glucose after you eat. Because meglitinides stimulate the release of insulin, it is possible to have low blood glucose when taking these medications.
Because the drugs listed above act in different ways to lower blood glucose levels, they may be used together to help meet your individualized diabetes goals.
For example, metformin and a DPP-4 inhibitor may be used together shortly after being diagnosed with type 2 diabetes to help keep blood glucose levels at goal.
That said, many combinations can be used. Work with your health care provider to find the combination of medicines that work best for you and your lifestyle and help you meet your health goals. Insulin may also be used to treat type 2 diabetes. Learn more.
Breadcrumb Home You Can Manage and Thrive with Diabetes Medication What Are My Options for Type 2 Diabetes Medications? DPP-4 Inhibitors DPP-4 inhibitors help improve A1C a measure of average blood glucose levels over two to three months without causing hypoglycemia low blood glucose.
There are four DPP-4 inhibitors currently on the market in the U. SGLT2 Inhibitors Glucose in the bloodstream passes through the kidneys where it can either be excreted in the urine or reabsorbed back into the blood.
No matter what oral hypoglycemic agent the clinician prescribes, interprofessional team members must know the adverse effects and potential for interaction with other medications, offer counsel on diet and exercise, and work collaboratively to optimize therapeutic results.
Disclosure: Kavitha Ganesan declares no relevant financial relationships with ineligible companies. Disclosure: Muhammad Burhan Majeed Rana declares no relevant financial relationships with ineligible companies.
Disclosure: Senan Sultan declares no relevant financial relationships with ineligible companies. This book is distributed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivatives 4. You are not required to obtain permission to distribute this article, provided that you credit the author and journal.
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StatPearls [Internet]. Treasure Island FL : StatPearls Publishing; Jan-. Show details Treasure Island FL : StatPearls Publishing ; Jan-. Search term. Oral Hypoglycemic Medications Kavitha Ganesan ; Muhammad Burhan Majeed Rana ; Senan Sultan. Author Information and Affiliations Authors Kavitha Ganesan 1 ; Muhammad Burhan Majeed Rana 2 ; Senan Sultan.
Affiliations 1 Orange Park Medical Center. Continuing Education Activity The most effective management of diabetes mellitus demands an interprofessional approach involving both lifestyle modifications with diet and exercise and pharmacologic therapies as necessary to meet individualized glycemic goals.
Indications 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. Mechanism of Action Sulfonylureas bind 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.
Administration Glipizide is a 2. Contraindications The following are contraindications for different classes of oral hypoglycemic drugs.
Sulfonylureas : Hypersensitivity to the drug or sulfonamide derivatives, type 1 diabetes mellitus, and diabetic ketoacidosis. Pioglitazone : Hypersensitivity to the drug, New York Heart Association Class III or IV heart failure, serious hepatic impairment, bladder cancer, history of macroscopic hematuria, and pregnancy.
Alpha-glucosidase inhibitors : Hypersensitivity to acarbose, diabetic ketoacidosis, cirrhosis, inflammatory bowel disease, ulcers of the intestine, partial intestinal obstruction, digestive and absorptive issues. SGLT 2 inhibitors : History of serious hypersensitivity to the drug, end-stage renal disease ESRD , and patients on dialysis.
Linagliptin does not need any dose adjustment. Monitoring Fasting blood sugar, pre-meal blood sugar, and hemoglobin A1c are measured semi-annually in patients with good blood sugar control and quarterly in those who did not meet treatment goals or have a change in therapy.
In patients taking metformin, initial and frequent monitoring of hemoglobin, RBC indices, and renal function tests before therapy initiation, and at least every year. Serum vitamin B12 and folate levels should be measured if the patient is on long-term metformin to rule out megaloblastic anemia.
In patients taking pioglitazone, aspartate transaminase, alanine transaminase, alkaline phosphatase, and total bilirubin are measured before initiation and periodically. Signs and symptoms of heart failure, weight gain, features suggestive of bladder cancer hematuria, dysuria, and urinary urgency , and periodic ophthalmologic exams require monitoring.
Note any signs and symptoms of hypoglycemia fatigue, excessive hunger, profuse sweating, numbness of extremities , abnormal liver function, and weight fluctuations due to the potential to cause weight gain in patients taking sulfonylureas.
In patients taking acarbose, serum creatinine and serum transaminase levels should be monitored every three months during the first year of treatment and periodically thereafter.
Renal function baseline and periodically during treatment and LDL require monitoring for patients with SGLT 2 inhibitors. Enhancing Healthcare Team Outcomes Oral hypoglycemic agents are often prescribed by the primary care provider, nurse practitioner or PA, endocrinologist, and internist.
Review Questions Access free multiple choice questions on this topic. Comment on this article. References 1. Liu Z, Yang B. Drug Development Strategy for Type 2 Diabetes: Targeting Positive Energy Balances.
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Drugs used in Anti-diabetic medications treat diabetes Anti--diabetic by decreasing the medicagions level in the blood. With the exception of Anti-diabetic medications meidcations, most GLP receptor Anti-diabetic medications liraglutideElliptical trainer sessionsand Anti-diabetic medicationsand pramlintideall are administered orally and are thus also called oral hypoglycemic agents or oral antihyperglycemic agents. There are different classes of hypoglycemic drugs, and their selection depends on the nature of 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.
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