Diabetes is a pathological condition where blood sugar is high. It is a very common endocrinological disorder prevailing all over the world. Some oral medications are used to treat diabetes(especially type 2 diabetes) and reduce blood sugar.
The main mechanism of action these drugs are stimulating the pancreas to secrete insulin and thereby reducing serum glucose. These are usually metabolized by the liver.
Chlorpropamide, Tolbutamide, Tolazamide, Acetohexamide are 1st generation Sulfonylureas.
Maximum drugs of these groups are not used due to side effects chlorpropamide causes cholestatic jaundice. Prolong hypoglycemia and weight gain are also common rare side effects includes skin rashes and thrombocytopenia.
Glipizide, Gliclazide, Glimepiride, Glibenclamide, Glyburide are commonly used as 2nd generation sulfonylureas.
Old patients with cardiac diseases are usually avoided as there is a high risk of fatal hypoglycemia. Glibenclamide causes maximum hypoglycemia. Glimepiride and Gliclazide are available in modified release form with a low risk of hypoglycemia.
Drugs belong to meglitinide analogs are Repaglinide and nateglinide .
Repaglinide can be used in case of renal failure.
Weight gain and hypoglycemia are common adverse effects.
This is the novel drug for type 2 diabetes Lipogenesis, Gluconeogenesis. Avoided in patients with renal failure and hepatic failure. Metformin should not be used in a patient with a high risk of lactic acidosis.
This drug belongs to group thiazolidinediones. It does not cause hypoglycemia. Pioglitazone also helps to reduce triglyceride and increase HDL (High-Density Lipoprotein). It activates a receptor named as PPAR-γ (Peroxisome Proliferator-Activated Receptor Gamma). Clinical studies found that pioglitazone decreases the risk of cardiovascular diseases like myocardial infarction and stroke.
Pioglitazone has multiple side effects like –
These drugs inhibit the absorption of glucose. They inhibit enzymes like glucoamylase and Alpha-amylase. Hence, these medications are useful to reduce postprandial blood sugar.
Acarbose causes flatulence, abdominal bloating and diarrhea. Similar side effects are also found in miglitol. Miglitol is excreated without any metabolism through the kidney. For this reason, miglitol should be avoided in end-stage renal disease.
DPP 4 inhibitors are oral drugs. Sitagliptin, Saxagliptin, Vildagliptin, Teneligliptin, Linagliptin, Alogliptin have commonly used DPP 4 inhibitors and used to treat type 2 Diabetes. Linagliptin excreted through bile without any metabolism.
Sitagliptin side effects are nasopharyngitis, angioedema, pancreatitis, Steven Jhonson syndrome, etc.
Alogliptin is highly hepatotoxic and causes hepatic failure. Vildagliptin side effects include headache, dizziness and hepatitis. The liver function test should be done regularly during the use of vildagliptin and alogliptin. Linagliptin causes respiratory trace infection, angioedema, urticaria, and pancreatitis. Saxagliptin side effects include respiratory tract infection, urinary tract infection, and headache. It also increases the risk of heart failure.