Oral Hypoglycemic Drugs And Classifications Heider SH. Qassam MSc.PH. & TH.

Goal To understand Oral Hypoglycemic Drugs And Classifications

Oral Hypoglycemic Drugs: These agents are useful in the treatment of patients who have Type 2 diabetes but who cannot be managed by diet alone.

Oral Hypoglycemic Classification Insulin Secretagogues Insulin Sensitizers I.Sulfonylureas III.Biguanides IV. Thiazolidinediones II.Meglitinide analogs V.α-Glucosidase Inhibitors

I.Sulfonylureas (mechanism of action) : Increase release of insulin Decrease production of glucose in the liver Increase the number of insulin receptors Effective only if have functioning beta cells Side effect is hypoglycemia and weight gain These drugs include glibenclamide, glipizide, and glimepiride .

II.Meglitinides Nateglinide and repaglinide are nonsulfonylureas that lower blood sugar by stimulating pancreatic secretion of insulin In contrast to the sulfonylureas, the meglitinides have a rapid onset and a short duration of action They are categorized as postprandial glucose regulators Monotherapy or in combination with metformin Should be taken 1 to 30 minutes before a meal Side effects hypoglycemia and weight gain

III.Biguanides (mechanism of action): increases the use of glucose by muscle and fat cells, decreases hepatic glucose production, and decreases intestinal absorption of glucose Does not cause hypoglycemia May be used alone or in combination Side effects include GIT disturbance and lactic acidosis Contraindicated in liver or renal impairment. Can result in lactic acidosis. This group include metformin

IV. Thiazolidinediones (mechanism of action):Decrease insulin resistance. Through binding with PPAR lead to regulation adipocyte production and secretion of fatty acids as well as glucose metabolism, resulting in increased insulin sensitivity in adipose tissue, liver, and skeletal muscle Side effects include weight gain, headache and anemia Contraindicated in patients with liver disease and acute MI May be used as monotherapy or in combination with insulin, metformin or a sulfonylurea These drugs include Pioglitazone and rosiglitazone

Alpha glucosidase Inhibitors Include acarbose and miglitol (mechanism of action): inhibit alpha-glucosidase enzymes in GI tract. Delays absorption of complex CHO and simple sugars Can be combined therapy with sulfonylurea Contraindicated in malabsorption, severe renal impairment Side effects include bloating and diarrhea

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