1. Oral hypoGLYCEMICS

2. Classes Sulfonylureas Biguanides Sulfonylureas+biguanide combination
Thiazolidinediones
Alpha-glycosidase inhibitors
Meglitinides
Dipeptidyl Peptidase-4 (DPP-4) Inhibitor

3. Sulfonylureas
Stimulate β cells to produce more insulin by opening calcium channels

4. Sulfonylureas … 1st generation 3rd generation 2nd generation
Tolbutamide (Orinase)
Tolazamide (Tolinase)
Chlorpropamide (Diabinese)
2nd generation
Glyburide (Micronase)
Glipizide (Glucotrol)
3rd generation
Glimepiride (Amaryl)

5. Biguanides
Improves insulin sensitivity by increasing peripheral glucose uptake & utilization
Metformin (Glucophage)
Monotherapy, or combined with sulfonylureas e.g. Glucovance (Glyburide & Metformine)
*only anti-diabetic drug that has been proven to reduce the complications of diabetes, as evidenced in a large study of overweight patients with diabetes (UKPDS 1998).

6. Thiazolidinediones (Glitazones)
Make cells more sensitive to insulin (esp. fatty cells)
Pioglitazone (Avandia)

7. Αlpha-Glycosidase Inhibitors
Block enzymes that help digest starches hence delay absorption of complex carbohydrates in the intestine
Acarbose (Precose)
Miglitol (Glyset)

8. Meglitinides Stimulate pancreas to secrete more insulin
Repaglinide (Prandin)
Nateglinide (Starlix) [D-phenylalanine derivative]

9. Dipeptidyl Peptidase-4 (DPP-4) Inhibitor
Increase and prolongs the action of incretin, a hormone that increases insulin release
Vildagliptin (Galvus)
Sitagliptin (Januvia)

10. Summary Sulfonylureas stimulate β cells
Biguanides improves insulin’s ability to move glucose
Sulfonylureas and biguanide combination drugs BOTH
Thiazolidinediones cells more sensitive to insulin
Alpha-glycosidase inhibitors Block enzymes that help digest starches
Meglitinides stimulate β cells (dependant upon glucose conc.)
Dipeptidyl Peptidase-4 (DPP-4) Inhibitor increases insulin release