Anti Diabetics drugs

 Anti-Diabetic drugs

Anti-diabetic drugs are medicines used to treat hyperglycemic conditions and control blood sugar levels in diabetic patients. Anti-diabetic drugs include:

• Insulin
• Oral hypoglycemic agents

Insulin

Insulin is used to treat type 1 diabetes patients. In type 1 diabetes, insulin deficiency occurs due to the destruction of β cells in the pancreas.

Insulin is a polypeptide hormone and is produced by recombinant DNA technology. When taken orally it is degraded in the gastrointestinal tract. Therefore, it is generally administered by subcutaneous injection into the body.

Oral hypoglycemic agents

Oral hypoglycemic agents or oral diabetes medications treat patients with type 2 diabetes. In type 2 diabetes, the pancreas retains some β cell function, but insulin secretion is insufficient to maintain glucose levels.

Types of oral hypoglycemic agents

There are several different classes of diabetes medication, that work in different ways to manage blood glucose levels. These may include:

• Sulfonylureas
• Glinides
• Biguanides
• Thiazolidinediones
• α-Glucosidase inhibitors
• Dipeptidyl peptidase-4 inhibitors
• Sodium-glucose cotransporter 2 inhibitors

Sulfonylureas

Sulfonylureas promotes insulin release from β cells of the pancreas and may also reduce hepatic glucose production.

Adverse effects of sulfonylureas include hypoglycemia, hyperinsulinemia, and weight gain. They should be used with caution in hepatic or renal insufficiency because these drugs are metabolized by the liver and excreted in urine and feces. 

The most used sulfonylureas in clinical practice are:

• Glybenclamide
• Glyburide
• Glipizide
• Glimepiride

Glinides

Glinides stimulate insulin secretion and have a rapid onset and a short duration of action. These should be taken prior to meal and are metabolized by CYP450 in the liver and excreted through bile.

Glinides includes:

• Repaglinide
• Nateglinide

Biguanides

Biguanides increase glucose uptake and slow intestinal absorption of sugars. It is also classified as an insulin sensitizer. This class contains only:

• Metformin

Thiazolidinediones( TZDs)

TZDs increase insulin sensitivity in adipose tissue, liver, and skeletal muscle and thus lower blood glucose levels.

It includes:

• Pioglitazone
• Rosiglitazone

α-Glucosidase inhibitors

These drugs reduce the digestion of carbohydrates, causing lower postprandial glucose levels. These include:

• Acarbose
• Miglitol

Dipeptidyl peptidase-4 inhibitors

These drugs inhibit the enzyme DPP-4, which is responsible for the inactivation of  GLP-1 and thus improves blood glucose levels. GLP-1 hormones increase the release of insulin and reduce the secretion of glucagon. These include:

• Alogliptin
• Linagliptin
• Saxagliptin
• Sitagliptin

Sodium-glucose cotransporter 2 inhibitors

These agents lower blood glucose level by decreasing reabsorption of glucose, increasing urinary glucose excretion.

These include:

• Canagliflozin
• Dapagliflozin
• Empagliflozin
• Ertugliflozin