1. Oral Hypoglycemic Drugs
Heider SH. AL-Qassam
MSc.PH. & TH.

2. Diabetes Mellitus
Chronic systemic disease characterized by metabolic abnormalities
Disorder of carbohydrate metabolism
Results from inadequate production of insulin

3. Diabetes Mellitus Characterized by glucosuria and hyperglycemia
Two forms—Type 1 and Type 2
Type 1—patient's βcells are destroyed this willcause absolute insulin deficiency
Type 2ــــ patient secretes insufficient amounts of insulin and insulin receptors are resistant to existent circulating insulin

4. Oral Hypoglycemic Drugs
II. Insulin Sensitizers
Insulin Secretagogues
Sulfonylureas
Biguanides
Meglitinide analogs
glitazones
III.α-Glucosidase Inhibitors
IV.Dipeptidyl Peptidase-IV Inhibitors
V.Incretin Mimetics

6. 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
Primary side effect is hypoglycemia and weight gain
These drugs include glibenclamide, glipizide, and glimepiride .

7. 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 gian
caution in patients with hepatic impairment

8. 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

9. IV.Glitazones
(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

10. Alpha glucosidase Inhibitors
Include acarbose and miglitol
(mechanism of action): inhibit alpha-glucosidase enzymes (maltase, amylase, sucrase) 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

11. Incretin Mimetics
Exenatide is an incretin mimetic with a polypeptide homologous to GLP-1
It is improves glucose-dependent insulin secretion ,slows gastric emptying time, decreases food intake, decreases glucagon secretion, and promotes βcell proliferation
It must be administered subcutaneously
Side effects include nausea, vomiting, and diarrhea

12. newOral Agents: Dipeptidyl Peptidase-IV Inhibitors
Sitagliptin is an orally active dipeptidyl peptidase-IV inhibitor used for the treatment of patients with Type 2 diabetes
(Mechanism of action)
inhibits the enzyme DPP-IV, which is responsible for the inactivation of incretin hormones, such as glucagon-like peptide-1 (GLP-1).
Prolonging the activity of incretin hormones results in increased insulin release in response to meals
Adverse effects include nasopharyngitis and headache

13. Thank you