Antidiabetic drugs are medications used to treat diabetes mellitus by controlling blood glucose levels. They are classified based on their mechanism of action, chemical structure, and the type of diabetes they treat. Below is a classification of antidiabetic drugs with examples.
Insulin and Insulin Analogs
Used for: Type 1 Diabetes, Type 2 Diabetes (when oral medications are insufficient), and gestational diabetes.
Rapid-Acting Insulins:
Examples: Insulin lispro (Humalog), Insulin aspart (NovoRapid), Insulin glulisine (Apidra)
Onset: 10-30 minutes
Duration: 3-5 hours
Short-Acting Insulins:
Examples: Regular insulin (Humulin R, Novolin R)
Onset: 30-60 minutes
Duration: 5-8 hours
Intermediate-Acting Insulins:
Examples: NPH insulin (Humulin N, Novolin N)
Onset: 1-2 hours
Duration: 12-18 hours
Long-Acting Insulins:
Examples: Insulin glargine (Lantus), Insulin detemir (Levemir), Insulin degludec (Tresiba)
Onset: 1-2 hours
Duration: Up to 24 hours or more
Premixed Insulins:
Examples: Humalog Mix 75/25 (75% insulin lispro protamine, 25% insulin lispro), Novolog
Mix 70/30 (70% insulin aspart protamine, 30% insulin aspart)
Oral Antidiabetic Agents
Biguanides
Used for: Type 2 Diabetes
Examples: Metformin (Glucophage)
Mechanism: Decreases hepatic glucose production, and increases insulin sensitivity in peripheral tissues.
Primary Benefit: It does not cause weight gain and may assist with weight loss.
Sulfonylureas
Used for: Type 2 Diabetes
Examples: Glipizide (Glucotrol), Glyburide (Micronase, Diabeta), Glimepiride (Amaryl)
Mechanism: Stimulates insulin release from pancreatic beta cells.
Primary Benefit: Effective in reducing blood glucose, but may cause weight gain and
hypoglycemia.
Meglitinides (Glinides)
Used for: Type 2 Diabetes
Examples: Repaglinide (Prandin), Nateglinide (Starlix)
Mechanism: Stimulates rapid, short-term insulin release from the pancreas.
Primary Benefit: Shorter duration of action, reducing the risk of prolonged hypoglycemia.
Thiazolidinediones (Glitazones)
Used for: Type 2 Diabetes
Examples: Pioglitazone (Actos), Rosiglitazone (Avandia)
Mechanism: Increases insulin sensitivity by acting on PPAR-gamma receptors in adipose tissue, muscle, and liver.
Primary Benefit: Improves insulin resistance but may cause weight gain, edema, and a risk of heart failure.
DPP-4 Inhibitors (Dipeptidyl Peptidase-4 Inhibitors)
Used for: Type 2 Diabetes
Examples: Sitagliptin Januvia), Saxagliptin (Onglyza), Linagliptin (Tradjenta)
Mechanism: Inhibits the enzyme DPP-4, which increases levels of incretin hormones, enhancing insulin release and lowering glucagon secretion.
Primary Benefit: Does not cause weight gain and has a low risk of hypoglycemia.
SGLT2 Inhibitors (Sodium-Glucose Cotransporter-2 Inhibitors)
Used for: Type 2 Diabetes
Examples: Canagliflozin (Invokana), Dapagliflozin (Farxiga), Empagliflozin Gardiance)
Mechanism: Inhibits SGLT2 in the proximal tubule of the kidney, reducing glucose reabsorption and increasing urinary glucose excretion.
Primary Benefit: This can lead to weight loss and a reduced risk of cardiovascular events.
Alpha-Glucosidase Inhibitors
Used for: Type 2 Diabetes
Examples: Acarbose (Precose), Miglitol (Glyset)
Mechanism: Inhibits alpha-glucosidase enzymes in the intestines, delaying carbohydrate digestion and glucose absorption.
Primary Benefit: Lowers postprandial blood glucose levels but may cause gastrointestinal side effects.
Injectable Non-Insulin Agents
GLP-1 Receptor Agonists (Glucagon-Like Peptide-1 Receptor Agonists)
Used for: Type 2 Diabetes
Examples: Exenatide (Byetta), Liraglutide (Victoza), Semaglutide (Ozempic), Dulaglutide (Trulicity)
Mechanism: Mimics the action of GLP-1, enhancing insulin secretion, inhibiting glucagon release, and slowing gastric emptying.
Primary Benefit: Promotes weight loss, has a low risk of hypoglycemia, and provides
cardiovascular benefits.
Amylin Analogs
Used for: Type 1 and Type 2 Diabetes
Examples: Pramlintide (Symlin)
Mechanism: Mimics amylin, a hormone co-secreted with insulin, which helps regulate blood
glucose by slowing gastric emptying and suppressing glucagon secretion.
Primary Benefit: Reduces postprandial glucose spikes, but must be used in conjunction with
insulin.
Combination Therapies
Used for: Type 2 Diabetes
Examples:
Metformin + Sitagliptin Janumet)
Metformin + Glipizide (Metaglip)
Pioglitazone + Glimepiride (Duetact)
Mechanism: Combination therapies utilize multiple mechanisms of action to achieve better glycemic control by targeting different aspects of glucose metabolism.
Emerging and Other Therapies
Bromocriptine (Cycloset): A dopamine agonist used in the treatment of Type 2 diabetes.
Colesevelam (Welchol): A bile acid sequestrant that also lowers blood glucose levels, used as an adjunct therapy.
Antidiabetic drugs come in various classes, each with unique mechanisms of action to address different aspects of glucose metabolism. The choice of therapy is based on the type of diabetes, the patient's medical history, and the specific glycemic targets. Combination therapy is often employed to enhance efficacy and minimize side effects, with the goal of achieving optimal blood glucose control and preventing diabetes-related complications.
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