Treatment of Diabetes: Best Diabetes Plan for People.
Diabetes is a common disease. But every one
requires unique care. In this blog, I try to discuss its all features. I encourage diabetic
people their families, to learn about the possible approaches for diabetes, as
well as healthy lifestyle choices too.
Almost
all Type 2 diabetes has a number of drug treatment options to be taken by mouth
known as oral antihyperglycemic drugs or oral hypoglycemic drugs. Oral
diabetes drugs are usually reserved for use only after lifestyle measures have
been unsuccessful in lowering glucose levels to the target of an HbA1c below
7.0%, achieved through an average glucose reading of around 8.3-8.9 mmol/L
(around 150-160 mg/dL).
The
lifestyle measures that are critical to type 2 diabetes management
are diet and exercise, and these remain an important part of
treatment when pills are added.
People
with type 1 diabetes cannot use oral pills for treatment, and must instead
take insulin.
How do oral drugs lower glucose levels?
Metformin
is the most widely used oral antihyperglycemic drug and reduces the amount of
glucose released by the liver into the bloodstream.
Oral
antihyperglycemic drugs have three modes of action to reduce blood glucose
levels:3
·
Secretagogues
enhance insulin secretion by the pancreas
·
Sensitizers
increase the sensitivity of the peripheral tissues to insulin
·
Inhibitors
impair gastrointestinal absorption of glucose.
Each
class of antihyperglycemic drug has a different adverse event or safety
profile, and side effects are the main consideration when it comes to choosing
a medication.
Must
Read :- 9 EARLY SIGNS AND SYMPTOMS OF DIABETES
Possible
side effects range from weight gain, through gastrointestinal ones such as
diarrhea, to pancreatitis and more serious problems. Hypoglycemia is also a
possible adverse event.
What oral drugs are available for type 2 diabetes?
No
one particular choice of oral hypoglycemic is considered the most effective
form of treatment - the decision over which drug to use is instead based on:1-3
·
Consideration
of the adverse side effects
·
Convenience
and overall tolerability
·
Personal
preference.
In
reality, weighing up each drug is something to do in partnership with a
prescriber - guidelines partly drawn up by the American Diabetes Association
list a great number of advantages and disadvantages for each of the
available drug treatments, including the consideration of cost.
The
use of a single drug can be escalated to combination therapy with a second drug
in an effort to improve glycemic control.
Metformin is
usually the first treatment offered, however, and it is the most widely used
oral antihyperglycemic. Metformin is a sensitizer in the class known as
biguanides; it works by reducing the amount of glucose released by the liver
into the bloodstream and increasing cellular response to insulin. A metformin
pill is usually taken twice a day.
This
drug is a low-cost antihyperglycemic with mild side effects that can include
diarrhea and abdominal cramping. Metformin is not associated with weight gain
or hypoglycemia.
Sulphonylureas are
secretagogues that increase pancreatic insulin secretion. There are several
drug names in this class, including:
·
Chlorpropamide
·
Glimepiride
·
Glipizide
·
Glyburide.
Again,
the choice of drug is an individual one. In the case of sulphonylureas, the
choice depends on daily dosing and the level of side effects. These drugs are
associated with weight gain and hypoglycemia.
Glitazones
(also known as thiazolidinediones) are sensitizers - they increase the
effect of insulin in the muscle and fat and reduce glucose production by the
liver.
Two
glitazones are available: pioglitazone and rosiglitazone. These drugs can have
the side effects of weight gain or swelling and are associated with increased
risks of heart disease and stroke, bladder cancer and fractures.
In
the UK, rosiglitazone was withdrawn from the market over concerns about adverse
events.4 In 2015, it remains available in the US, with information on
its safety provided by the US Food and Drug Administration (FDA).
Alpha-glucosidase
inhibitors are intestinal enzyme inhibitors that block the breakdown of
carbohydrates into glucose, reducing the amount absorbed in the gut.
Available
as acarbose and miglitol, they are not usually tried as first-line drugs
because of common side effects of flatulence, diarrhea and bloating, although
these may reduce over time.1,3,4
Dipeptidyl
peptidase-4 (DPP4) inhibitors include alogliptin, linagliptin, saxagliptin
and sitagliptin.
Also
known as gliptins, DPP4 inhibitors have a number of effects, including
stimulating pancreatic insulin (by preventing the breakdown of the hormone
GLP-1). They may also help with weight loss through an effect on appetite.1-4
These
drugs do not increase the risk of hypoglycemia. Mild possible side effects are
nausea and vomiting.
Sodium-glucose
co-transporter 2 (SGLT2) inhibitors include canagliflozin and
dapagliflozin. They work by inhibiting the reabsorption of glucose in the
kidneys, causing glucose to be excreted in the urine (glycosuria).
SGLT2s
may also cause modest weight loss. Side effects include urinary infection.
Meglitinides include
repaglinide and nateglinide. They stimulate the release of insulin by the
pancreas. Meglitinides are associated with a higher chance of hypoglycemia and
must be taken with meals three times a day. As a result, these drugs are less
commonly used.
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