Anti-Diabetic Medications & Non-Pharmacologic Management

• Anti-diabetic medications are classified into different groups based on their mechanisms or mode of action.

Non-Pharmacologic Management of Diabetes

• Counselling for mental closure to DENIAL can help patients come to terms with their condition.
• Gaining patient CONCORDANCE ensures compliance with medication use.
• Educating patients about their disease and potential complications is essential.
• Education about proper personal bodily care is needed because wounds can become difficult to heal.
• Diet and management to stay within a healthy BMI are crucial.
• Moderate consistent exercise and reduction in alcohol consumption are recommended.
• Quitting smoking is also important for overall health.

Classifications of Anti-Diabetic Medications

• Insulin Sensitizers: Enhance the body's response to insulin.
• Insulin Secretagogues: Stimulate insulin secretion.
• Dipeptidyl Peptidase-4 (DPP-4) Inhibitors (AGLIPTINS): Prolong the action of incretins.
• Incretin Mimetics or Glucagon-Like Peptide-1 (GLP-1) Receptor Agonists: Mimic incretins.
• Sodium-Glucose Co-Transporter-2 (SGLT-2) Inhibitors: Affect glucose reabsorption in the kidneys.
• Insulins: Replace or supplement the body's insulin supply.

Insulin

• Important considerations for insulin usage include dosing, storage, administration techniques, site of administration, lipodystrophy, and potential side effects.

Incretins

• Glucagon-like Peptide 1 (GLP-1) is produced in the L-cells of the intestinal lining when food is ingested, stimulating the pancreas to release insulin.
• Incretins are a group of gut-derived hormones that enhance insulin secretion in response to food intake.
• An example of an incretin is Glucagon-like peptide-1 (GLP-1).
• Incretins stimulate insulin release from pancreatic beta cells in response to food.

Insulin Sensitizers

• Insulin sensitizers improve the body's response to insulin, effectively lowering blood glucose levels without increasing insulin secretion.
• These drugs are commonly used in managing type 2 diabetes mellitus (T2DM).
• Examples of insulin sensitizers include:
  • Biguanides
  • Thiazolidinediones

Biguanides

• Biguanides, such as Metformin and Fenformin, increase cells insulin sensitivity.
• Metformin's side effects include gastrointestinal discomfort.
• Metformin is weight-gain NEUTRAL because it does not increase insulin secretion, helping prevent weight gain associated with fat storage.
• The typical dose of Metformin is 500mg to 1g daily, up to a maximum of 2.5g daily.
• Fenformin is banned due to its side effect of intense diabetes ketoacidosis (DKA).

Thiazolidinediones (TZDs)

• Thiazolidinediones (GLITAZONES), such as Pioglitazone and Rosiglitazone, are associated with weight gain, fluid retention, and an increased risk of heart failure.

Insulin Secretagogues

• Examples include Glibenclamide, Glimepiride, and Gliclazide.
• These drugs stimulate pancreatic beta cells to release insulin.
• They cannot be used in type 1 diabetes.
• Common ones include Hypoglycemia and Weight gain

Dipeptidyl Peptidase-4 (DPP-4) Inhibitors

• Examples include Sitagliptin, Vildagliptin, and Saxagliptin.
• DPP-4 inhibitors prolong the action of incretins, thereby increasing insulin secretion.
• They prevent the degradation of incretins, prolonging their action.

Incretins Action

• They stimulate insulin release from pancreatic beta cells in a glucose-dependent manner.
• Incretins suppress glucagon secretion from pancreatic alpha cells, reducing hepatic glucose production.
• They also slow gastric emptying, leading to increased satiety.

Glucagon-Like Peptide-1 (GLP-1) Receptor Agonists

• Examples of GLP-1 Receptor Agonists, also known as incretin mimetics, include Exenatide, Liraglutide, and Semaglutide.
• A mimetic mimics or imitates a substance, structure, or function. In pharmacology, mimetic drugs imitate the effects of endogenous substances.
• An agonist binds to a receptor and activates it, mimicking the action of endogenous molecules to stimulate a physiological effect.

OZEMPIC (Semaglutide)

• Ozempic (semaglutide) is a GLP-1 receptor agonist mainly used for treating type 2 diabetes mellitus (T2DM) and, in some cases, for weight management.
• It is injectable and usually given once weekly to improve blood sugar control.
• Ozempic mimics glucagon-like peptide-1 (GLP-1,) stimulating pancreatic beta cells to release insulin in response to elevated blood glucose levels.

Sodium-Glucose Co-Transporter-2 (SGLT-2) Inhibitors

• Examples include Canagliflozin, Dapagliflozin, and Empagliflozin .
• SGLT-2 inhibitors inhibits renal glucose reabsorption, leading to glucose excretion in urine, and have additional cardiovascular benefits.
• Common side effects include genital and urinary tract infections and dehydration.
• SGLT-2 inhibitors work by blocking the reabsorption of glucose in the kidneys, which leads to increased glucose excretion and lower blood sugar levels.
• Advantages of SGLT-2 inhibitors include weight loss and a low risk of hypoglycemia.
• Increased risk of genital and urinary tract infections is among the side effects due to increased glucose found in urine.
• Forxega (Dapagliflozin) is a popular example of an SGLT-2 inhibitor in Ghana.

Note on Combination Medications

• Some anti-diabetic medications contain two or more drugs from different classifications.
• For example, GALVUSMET contains Metformin and Vildagliptin, belonging to the insulin sensitizers and DPP-4 inhibitors classes.

Explore anti-diabetic medications and their classifications based on mechanisms of action. Learn about non-pharmacologic management strategies for diabetes, including counseling, patient education, diet, exercise, and lifestyle modifications. Understand the importance of concordance and personal care for preventing complications.