Oral Medications to Treat Type 2 Diabetes.ppt

Oral Medications to Treat Type 2 Diabetes Major Classes of Medications 1. Drugs that sensitize the body to insulin and/or control hepatic glucose production 2. Drugs that stimulate the pancreas to make more insulin 3. Drugs that slow the absorption of starches Thiazolidinediones Biguanides Sulfonylureas Meglitinides Alpha-glucosidase inhibitors Thiazolidinediones Thiazolidinediones decrease insulin resistance by making muscle and adipose cells more sensitive to insulin. They also suppress hepatic glucose production. Efficacy Decrease fasting plasma glucose ~35-40 mg/dl (1.9-2.2 mmol/L) Reduce A1C ~0.5-1.0% 6 weeks for maximum effect Other Effects Weight gain, edema Hypoglycemia (if taken with insulin or agents that stimulate insulin release) Contraindicated in patients with abnormal liver function or CHF Improves HDL cholesterol and plasma triglycerides; usually LDL neutral Medications in this Class: pioglitazone (Actos), rosiglitazone (Avandia), [troglitazone (Rezulin) - taken off market due to liver toxicity] Biguanides Biguanides decrease hepatic glucose production and increase insulin-mediated peripheral glucose uptake. Efficacy Decrease fasting plasma glucose 60-70 mg/dl (3.3-3.9 mmol/L) Reduce A1C 1.0-2.0% Other Effects Diarrhea and abdominal discomfort Lactic acidosis if improperly prescribed Cause small decrease in LDL cholesterol level and triglycerides No specific effect on blood pressure No weight gain, with possible modest weight loss Contraindicated in patients with impaired renal function (Serum Cr 1.4 mg/dL for women, or 1.5 mg/dL for men) Medications in this Class: metformin (Glucophage), metformin hydrochloride extended release (Glucophage XR) Sulfonylureas Sulfonylureas increase endogenous insulin secretion Efficacy Decrease fasting plasma glucose 60-70 mg/dl (3.3-3.9 mmol/L) Reduce A1C by 1.0-2.0% Other Effects Hypoglycemia Weight gain No specific effect on plasma lipids or blood pressure Generally the least expensive class