Non-Insulin Medications for Diabetes Treatment

Non-Insulin Medications for Diabetes Treatment

• Biguanides (Metformin):

  • First-line treatment for type 2 diabetes.
  • Lowers glucose production in the liver and improves tissue response to insulin.
  • Excreted unchanged by the kidneys, use with caution in renal impairment.
  • Common side effects: decreased appetite, nausea, diarrhea, potential weight loss.
  • Black box warning: severe metabolic acidosis can occur in patients with significant renal impairment.
  • Therapeutic uses: glycemic control and type 2 diabetes prevention.

• Sulfonylureas:

  • Two generations; second-generation (e.g., glipizide) is more potent with fewer drug interactions.
  • Stimulate insulin release from the pancreas
  • Primarily used for type 2 diabetes, typically with lifestyle changes.
  • Potentially cause hypoglycemia, especially in patients with renal or liver dysfunction.

• Meglitinides (Glinides, e.g., Repaglinide):

  • Stimulate insulin release, but shorter acting than sulfonylureas.
  • Taken with each meal.
  • Used for type 2 diabetes; less effective if sulfonylureas are ineffective.
  • Monotherapy or combined with metformin or glitazones.
  • Side effect: hypoglycemia; eat within 30 minutes of taking.

• Thiazolidinediones (Glitazones, e.g., Pioglitazone):

  • Primarily reduce insulin resistance.
  • Primarily used for type 2 diabetes, often given in addition to metformin.
  • Side effects: upper respiratory infections, headache, sinusitis, myalgia.
  • Black box warning: associated with heart failure due to fluid retention.
  • May cause ovulation and increase risk of unintended pregnancy in premenopausal women.
  • Possible increased risk for bladder cancer, fractures in women, and hepatic failure (monitor LFTs).

• α-Glucosidase Inhibitors:

  • Delay carbohydrate absorption, slowing blood glucose rise after meals.
  • Used for type 2 diabetes in conjunction with lifestyle changes.
  • Used alone or with insulin, metformin, or sulfonylureas.
  • Common side effects: flatulence, cramps, abdominal distension, diarrhea, potential iron malabsorption.
  • Potential for hypoglycemia when combined with insulin or sulfonylureas.
  • Long-term, high-dose therapy may cause liver dysfunction.

• Dipeptidyl Peptidase-4 Inhibitors (Gliptins, e.g., Sitagliptin):

  • Enhance incretin hormone action (stimulate insulin release, suppress glucagon).
  • Second-line treatment often added to metformin.
  • Side effects: upper respiratory infections, headache, nasal/throat inflammation, potential pancreatitis.

• Sodium-glucose co-transporter 2 (SGLT-2) Inhibitors (e.g., Canagliflozin):

  • Block glucose reabsorption in the kidneys, increasing glucose excretion.
  • Side effects: female genital infections, urinary tract infections, increased urination, potential dehydration and hypotension in older adults, especially with diuretics.
  • Drug interactions with certain medications (e.g., rifampin, phenytoin).

• Glucagon-like peptide-1 (GLP-1) Receptor Agonists (e.g., Exenatide):

  • Mimic GLP-1, slowing gastric emptying, stimulating insulin release, suppressing glucagon, and reducing appetite.
  • Often used as add-on therapy for type 2 diabetes.
  • Potential for dose-related hypoglycemia, especially with sulfonylureas.
  • Common side effects: gastrointestinal issues (nausea, vomiting, diarrhea), pancreatitis, and renal impairment limits use.