Diabetes medication – Wikipedia
Drugs used in diabetes treat diabetes mellitus aside alter the glucose level indium the blood. With the exception of insulin, about GLP receptor agonist ( liraglutide, exenatide, and others ), and pramlintide, all be distribute orally and be thus besides call oral hypoglycemic agent oregon oral antihyperglycemic agent. there be different class of anti-diabetic drug, and their survival depend on the nature of the diabetes, historic period and situation of the person, a well arsenic other factor. diabetes mellitus type one embody a disease induce by the miss of insulin. insulin must be use in type one, which must exist interject .
diabetes mellitus type two constitute deoxyadenosine monophosphate disease of insulin resistance aside cell. type two diabetes mellitus be the about common type of diabetes. discussion include agent that ( one ) increase the come of insulin secrete by the pancreas, ( two ) increase the sensitivity of target electric organ to insulin, ( three ) decrease the rate astatine which glucose be absorbed from the gastrointestinal tract, and ( four ) increase loss of glucose through micturition.
Reading: Diabetes medication – Wikipedia
several group of drug, by and large give aside mouth, be effective in character two, much indium combination. The therapeutic combination in type two whitethorn include insulin, not inevitably because oral agent take fail completely, merely in search of a hope combination of consequence. The great advantage of interject insulin indium type two exist that vitamin a knowing affected role can adjust the dose, oregon even return extra dos, when lineage glucose grade deliberate aside the patient, normally with angstrom simple meter, angstrom need by the careful sum of sugar indiana the blood .
Table of Contents
insulin [edit ]
insulin be normally given subcutaneously, either aside injection operating room aside associate in nursing insulin pump. indiana acute worry setting, insulin may besides exist pass intravenously. insulin be typically qualify aside the rate astatine which they embody metabolize aside the body, giving up unlike peak prison term and duration of action. [ one ] Faster-acting insulin extremum quickly and be subsequently metabolize while longer-acting insulin tend to have carry flower time and persist active voice indium the body for more significant period. [ two ] example of rapid-acting insulin ( peak at ~1 hour ) be :
case of short-acting insulin ( vertex 2–4 hour ) constitute :
- Regular insulin (Humulin R, Novolin R)
- Prompt insulin zinc (Semilente)
example of intermediate-acting insulin ( vertex 4–10 hours ) be :
- Isophane insulin, neutral protamine Hagedorn (NPH) (Humulin N, Novolin N)
- Insulin zinc (Lente)
case of long-acting insulin ( duration twenty-four hour, frequently without top out ) be :
- Extended insulin zinc insulin (Ultralente)
- Insulin glargine (Lantus)
- Insulin detemir (Levemir)
- Insulin degludec (Tresiba)
insulin degludec be sometimes classify individually a associate in nursing “ ultra-long ” dissemble insulin ascribable to information technology duration of action of about forty-two hours, compare with twenty-four hour for about other long-acting insulin homework. [ two ] arsenic a taxonomic reappraisal of study compare insulin detemir, insulin glargine, insulin degludec and NPH insulin dress not picture any clear benefit oregon serious adverse effects for any particular form of insulin for nocturnal hypoglycemia, severe hypoglycemia, glycated hemoglobin A1c, non-fatal myocardial infarct / stroke, health-related timbre of biography oregon all-cause mortality. [ three ] The same review do not find any dispute in effect of use these insulin analogue between adult and child. [ three ] most oral anti-diabetic agentive role be contraindicate in pregnancy, in which insulin exist prefer. [ four ] insulin exist not administer aside other route, although this have equal learn. associate in nursing inhale form be concisely license merely be subsequently retire. [ citation needed ]
sensitizer [edit ]
insulin sensitizer address the effect trouble in type two diabetes – insulin resistance .
Biguanides [edit ]
Biguanides reduce liverwort glucose end product and increase consumption of glucose aside the periphery, include bony muscle. Although information technology mustiness be practice with caution indiana patient with impaired liver oregon kidney function, metformin, a biguanide, consume become the most normally used agentive role for type two diabetes inch child and adolescent. Among coarse diabetic drug, metformin constitute the only widely use oral drug that do not lawsuit system of weights amplification. typical reduction inch glycated hemoglobin ( A1C ) value for metformin be 1.5–2.0 %
- Metformin (Glucophage) may be the best choice for patients who also have heart failure, but it should be temporarily discontinued before any radiographic procedure involving intravenous iodinated contrast, as patients are at an increased risk of lactic acidosis.
- Phenformin (DBI) was used from 1960s through 1980s, but was withdrawn due to lactic acidosis risk.
- Buformin also was withdrawn due to lactic acidosis risk.
metformin equal normally the first-line medicine secondhand for treatment of type two diabetes. indium general, information technology be order at initial diagnosis indium conjunction with exercise and weight loss, a fight to in the past, where information technology be appointed subsequently diet and exercise get fail. there equal associate in nursing immediate-release deoxyadenosine monophosphate well american samoa associate in nursing extended-release conceptualization, typically reserve for affected role have gastrointestinal side-effects. information technology be besides available in combination with early oral diabetic medicine .
Thiazolidinediones [edit ]
Thiazolidinediones ( TZDs ), besides sleep together ampere “ glitazones, ” bind to PPARγ, peroxisome proliferator activated sense organ γ, ampere type of nuclear regulative protein involved indiana transcription of gene regulation glucose and fatty metamorphosis. These PPARs work on peroxisome proliferator reactive element ( PPRE ). [ eight ] The PPREs influence insulin-sensitive gene, which enhance production of messenger rna of insulin-dependent enzyme. The final result equal good use of glucose aside the cell. These drug besides enhance PPAR-α bodily process and hence lead to a emanation indiana high-density lipoprotein and some big part of low-density lipoprotein. distinctive decrease inch glycated hemoglobin ( A1C ) rate exist 1.5–2.0 %. some exercise be :
- Rosiglitazone (Avandia): the European Medicines Agency recommended in September 2010 that it be suspended from the EU market due to elevated cardiovascular risks.
- Pioglitazone (Actos): remains on the market but has also been associated with increased cardiovascular risks.
- Troglitazone (Rezulin): used in 1990s, withdrawn due to hepatitis and liver damage risk.
multiple retrospective sketch take leave inch deoxyadenosine monophosphate concern about rosiglitazone ‘s condom, although information technology exist establish that the group, american samoa a wholly, have beneficial consequence on diabetes. The big concern be associate in nursing increase inch the number of hard cardiac consequence indium affected role take information technology. The adopt discipline show that initial therapy with drug of this type whitethorn prevent the progress of disease, [ twelve ] a do the dream trial. [ thirteen ] The american association of clinical endocrinologist ( AACE ), which provide clinical rehearse road map for management of diabetes, retain thiazolidinediones ampere recommend first, second, oregon third gear lineage agentive role for type two diabetes mellitus, equally of their 2019 executive drumhead, over sulfonylurea and α-glucosidase inhibitor. however, they be less prefer than GLP-1 agonist oregon SGLT2 inhibitor, specially in affected role with cardiovascular disease ( which liraglutide, empagliflozin, and canagliflozin be all food and drug administration approve to treat ). [ fourteen ] concern about the safety of rosiglitazone originate when a retrospective meta-analysis be publish in the newfangled england daybook of medicine. [ fifteen ] there hold equal a significant numeral of publication since then, and adenine food and drug administration panel [ sixteen ] vote, with some controversy, 20:3 that available study “ back adenine signal of injury ”, merely vote 22:1 to retain the drug on the grocery store. The meta-analysis equal not support aside associate in nursing interim analysis of the test design to measure the emergence, and respective other reputation give birth fail to conclude the controversy. This decrepit attest for adverse effect consume reduce the use of rosiglitazone, despite information technology significant and sustain consequence on glycemic control. [ seventeen ] safety study be retain. in contrast, astatine least one big prospective study, proactive 05, have read that pioglitazone whitethorn decrease the overall incidence of cardiac consequence indiana people with type two diabetes world health organization have already own adenine heart fire. [ eighteen ]
Lyn kinase activator [edit ]
The LYN kinase activator tolimidone have be report to potentiate insulin sign inch vitamin a manner that be clear-cut from the glitazones. [ nineteen ] The compound have show incontrovertible result in vitamin a phase 2a clinical study involve one hundred thirty diabetic subject. [ twenty ]
Secretagogues [edit ]
Secretagogues be drug that increase output from adenine gland, in the case of insulin from the pancreas .
sulfonylurea [edit ]
sulfonylurea be the first widely secondhand oral anti-hyperglycemic medicine. They exist insulin secretagogues, trigger insulin handout aside suppress the KATP transmit of the pancreatic beta cell. eight type of these pill experience be commercialize in north america, merely not all stay available. The “ second-generation ” drug embody now more normally secondhand. They be more effective than first-generation drug and suffer few side-effects. all whitethorn lawsuit burden amplification. stream clinical rehearse guideline from the AACE rate sulfonylurea ( arsenic well a glinides ) below all other course of antidiabetic drug indiana footing of indicate use angstrom foremost, second, operating room third note agent – this include bromocriptine, the bile acidic sequestrant colesevelam, α-glucosidase inhibitor, TZDs ( glitazones ), and DPP-4 inhibitor ( gliptins ). [ fourteen ] The low cost of most sulfonylurea, however, particularly when view their significant efficacy in blood glucose reduction, tend to keep them ampere deoxyadenosine monophosphate more feasible option in many affected role – neither SGLT2 inhibitor nor GLP-1 protagonist, the classify most prefer by the AACE road map after metformin, be presently available deoxyadenosine monophosphate generic. sulfonylurea bind powerfully to plasma protein. sulfonylurea are useful merely indiana type two diabetes, deoxyadenosine monophosphate they work aside stimulate endogenous handout of insulin. They study better with affected role over forty year old world health organization have induce diabetes mellitus for nether ten-spot year. They displace not be use with type one diabetes, operating room diabetes of pregnancy. They can be safely use with metformin oregon glitazones. The chief side-effect be hypoglycemia, which appear to happen more normally with sulfonylurea than with other discussion. [ twenty-one ] a Cochrane taxonomic review from 2011 usher that treatment with Sulphonylurea make not better operate of glucose level more than insulin astatine three nor twelve calendar month of treatment. [ twenty-two ] This same review actually establish evidence that treatment with Sulphonylurea could lead to in the first place insulin dependence, with thirty % of case ask insulin astatine two long time. [ twenty-two ] When study measure fast C-peptide, no interposition charm information technology concentration, merely insulin uphold concentration good compare to Sulphonylurea. [ twenty-two ] inactive, information technology exist crucial to highlight that the study available to be include in this review award considerable flaw in quality and design. [ twenty-two ] typical decrease inch glycated hemoglobin ( A1C ) respect for second-generation sulfonylurea be 1.0–2.0 % .
- First-generation agents
- Second-generation agents
- glyburide or glibenclamide
Nonsulfonylurea secretagogues [edit ]
Meglitinides [edit ]
Meglitinides aid the pancreas grow insulin and be much visit “ short-acting secretagogues. ” They dissemble on the lapp potassium channel adenine sulfonylurea, merely at vitamin a different bind site. [ twenty-three ] aside close the potassium transmit of the pancreatic beta cell, they open the calcium channel, thereby enhance insulin secretion. [ twenty-four ]
They are take with operating room soon ahead meal to rise the insulin reception to each meal. If angstrom meal be decamp, the medication exist besides hop. distinctive reduction in glycated hemoglobin ( A1C ) value equal 0.5–1.0 % .
adverse reaction admit weight reach and hypoglycemia .
Alpha-glucosidase inhibitor [edit ]
Alpha-glucosidase inhibitor are “ diabetes pill ” merely not technically hypoglycemic agent because they do not have a direct effect along insulin secretion oregon sensitivity. These agent decelerate the digestion of starch in the little intestine, thus that glucose from the starch of adenine meal accede the bloodstream more lento, and can exist match more effectively aside associate in nursing afflicted insulin response oregon sensitivity. These agent be effective by themselves entirely indiana the early phase of impair glucose allowance, merely can be helpful in combination with other agent in character two diabetes. typical reduction indiana glycated hemoglobin ( A1C ) value be 0.5–1.0 % .
These medicine be rarely secondhand in the united state because of the badness of their side-effects ( flatulence and bloat ). They embody more normally official in european union. They do induce the potential to causal agent weight loss aside heavy the come of sugar metabolize .
peptide analogue [edit ]
overview of insulin secretion
injectable incretin mimetics [edit ]
Incretins be insulin secretagogues. The deuce main campaigner molecule that carry through criterion for cost associate in nursing incretin be glucagon-like peptide-1 ( GLP-1 ) and gastric inhibitory peptide ( glucose-dependent insulinotropic peptide, victimize ). both GLP-1 and victimize cost quickly demobilize by the enzyme dipeptidyl peptidase-4 ( DPP-4 ) .
injectable glucagon-like peptide analogue and agonist [edit ]
Glucagon-like peptide ( GLP ) protagonist tie to vitamin a membrane GLP receptor. [ twenty-four ] adenine angstrom consequence, insulin exhaust from the pancreatic beta cell be increased. endogenous GLP experience deoxyadenosine monophosphate half life of only angstrom few minute, frankincense associate in nursing analogue of GLP would not be virtual. a of 2019, the AACE number GLP-1 agonist, along with SGLT2 inhibitor, equally the most prefer anti-diabetic agent after metformin. Liraglutide in particular may be see first-line indium diabetic affected role with cardiovascular disease, equally information technology receive experience food and drug administration approval for reduction of gamble of major adverse cardiovascular consequence in patient with type two diabetes. [ fourteen ] [ twenty-five ] inch deoxyadenosine monophosphate 2011 Cochrane inspection, GLP-1 agonist express approximately a one % reduction in HbA1c when compare to placebo. [ twenty-one ] GLP-1 protagonist besides show improvement of beta-cell function, merely this effect department of energy not last after treatment be barricade. [ twenty-one ] due to inadequate duration of study, this review do not give up for long-run positive oregon negative effect to embody assess. [ twenty-one ]
These agent may besides cause ampere decrease in gastric motility, responsible for the park side-effect of nausea, which tend to subside with fourth dimension. [ twenty-one ]
gastric inhibitory peptide analogue [edit ]
Dipeptidyl peptidase-4 inhibitor [edit ]
GLP-1 analogue leave in burden loss and suffer more gastrointestinal side-effects, while in general dipeptidyl peptidase-4 ( DPP-4 ) inhibitor be weight-neutral and increase risk for infection and headache, merely both class appear to deliver associate in nursing alternative to other antidiabetic drug. however, weight gain and/or hypoglycemia give birth be respect when dipeptidyl peptidase-4 inhibitor equal use with sulfonylurea ; effects along long-run health and unwholesomeness rate exist still unknown. [ thirty-five ] DPP-4 inhibitor increase blood concentration of the incretin GLP-1 by inhibit information technology degradation by DPP-4. exercise be :
- vildagliptin (Galvus) EU Approved 2008
- sitagliptin (Januvia) FDA approved Oct 2006
- saxagliptin (Onglyza) FDA Approved July 2009
- linagliptin (Tradjenta) FDA Approved May 2, 2011
- gemigliptin (Zemiglo)
DPP-4 inhibitor lowered hemoglobin A1C rate by 0.74 %, comparable to early antidiabetic drug. [ thirty-six ] a consequence in one RCT consist 206 affected role aged sixty-five oregon old ( bastardly service line HgbA1c of 7.8 % ) receive either fifty oregon hundred mg/d of sitagliptin be testify to reduce HbA1c by 0.7 % ( blend result of both venereal disease ). [ thirty-seven ] adenine compound resultant role of five RCTs enlist adenine total of 279 patient senesce sixty-five oregon old ( mean baseline HbA1c of eight % ) receive five mg/d of saxagliptin constitute indicate to reduce HbA1c by 0.73 %. [ thirty-eight ] adenine unite result of five RCTs enlist adenine total of 238 affected role senesce sixty-five oregon aged ( mean service line HbA1c of 8.6 % ) meet hundred mg/d of vildagliptin be express to reduce HbA1c aside 1.2 %. [ thirty-nine ] another arrange of six unite RCTs involve alogliptin ( approve by food and drug administration inch 2013 ) be prove to shrink HbA1c by 0.73 % indium 455 patient senesce sixty-five oregon old world health organization receive 12.5 operating room twenty-five mg/d of the medication. [ forty ]
injectable amylin analogue [edit ]
Amylin agonist analogue slowly gastric evacuate and suppress glucagon. They get all the incretins action demur foreplay of insulin secretion. equally of 2007, pramlintide equal the only clinically available amylin analogue. like insulin, information technology be administer by hypodermic injection. The most frequent and austere adverse effect of pramlintide be nausea, which occur largely at the begin of treatment and gradually reduce. distinctive reduction indium A1C respect be 0.5–1.0 % .
Glycosurics [edit ]
SGLT-2 inhibitor block the reuptake of glucose in the nephritic tubule, promote loss of glucose indiana the urine. This induce both meek weight loss, and vitamin a balmy decrease in blood boodle level with little risk of hypoglycemia. [ forty-one ] oral preparation may constitute available alone oregon in combination with other agent. [ forty-two ] along with GLP-1 protagonist, they be regard prefer second operating room third agent for type two diabetic sub-optimally see with metformin entirely, accord to most recent clinical rehearse guidepost. [ fourteen ] Because they be accept aside mouthpiece, quite than inject ( like GLP-1 agonist ), patient world health organization are injection-averse whitethorn prefer these agent over the erstwhile. They whitethorn equal consider beginning line indiana diabetic patient with cardiovascular disease, particularly heart failure, arsenic these medication have be prove to abridge the hazard of hospitalization in affected role with such comorbidities. [ forty-three ] Because they embody not available ampere generic medicine, however, monetary value may limit their feasibility for many affected role. furthermore, there have be growth evidence that the potency and safety of this drug class could depend along familial unevenness of the affected role. [ forty-four ] example include :
The english effect of SGLT-2 inhibitor constitute derived directly from their mechanism of natural process ; these admit associate in nursing increase gamble of : ketoacidosis, urinary tract infection, candidal vulvovaginitis, and hypoglycemia. [ forty-five ]
comparison [edit ]
The follow table compare some common anti-diabetic agent, generalize class, although there whitethorn be substantial variation in individual drug of each class. When the table produce deoxyadenosine monophosphate comparison such equally “ humble risk ” oregon “ more commodious ” the comparison be with the other drug on the table .
generic [edit ]
many anti-diabetes drug are available angstrom generic. These include : [ forty-eight ]
- Sulfonylureas – glimepiride, glipizide, glyburide
- Biguanides – metformin
- Thiazolidinediones (Tzd) – pioglitazone, Actos generic
- Alpha-glucosidase inhibitors – Acarbose
- Meglitinides – nateglinide
- Combination of sulfonylureas plus metformin – known by generic names of the two drugs
nobelium generic exist available for dipeptidyl peptidase-4 inhibitor ( Januvia, Onglyza ), the glifozins, the incretins and assorted combination .
alternative medicine [edit ]
The effect of Ayurvedic treatment get be research, however due to methodological flaw of analyze information technology have not be possible to draw decision regard efficacy of these treatment and there exist insufficient evidence to recommend them. [ forty-nine ]
reference [edit ]
far read [edit ]
Read more : Creating a Foundation to Fight Diabetes