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Oral Medications For Type 2 Diabetes Mellitus

Oral Medications For The Treatment Of Type-2 Diabetes Mellitus

Oral anti-diabetes can be divided into six classes. Each class of oral anti-diabetes lowers blood sugar level through unique mechanism.

Class of Anti-Diabetes Tablet

  1. Biguanides

Examples of medication :

  1. Metformin (Glucophage®),
  2. Metformin XR (Glucophage XR®),
  3. Metformin + Glibenclamide (Glucovance®),
  4. Metformin + Glimepiride (Amaryl M®),
  5. Metformin + Rosiglitazone (Avandamet®),
  6. Metformin + Pioglitazone (Actoplus Met®),
  7. Metformin + Sitagliptin (Janumet®),
  8. Metformin + Vildagliptin (Galvusmet®),
  9. Metformin + Saxagliptin (Kombiglyze XR®).
  1. Sulfonylurea

Examples of medication :

  1. Glibenclamide (Daonil®),
  2. Gliclazide (Diamicron®),
  3. Gliclazide MR (Diamicron MR®),
  4. Glimepiride (Amaryl®),
  5. Metformin + Glimepiride (Amaryl M®).
  1. Alpha-Glucosidase Inhibitor

Examples of medication :

  1. Acarbose (Glucobay®),
  2. Miglitol (Glyset®).
  1. Thiazolidinediones

Examples of medication :

  1. Rosiglitazone (Avandia®),
  2. Pioglitazone (Actos®),
  3. Metformin + Rosiglitazone (Avandamet®),
  4. Metformin + Pioglitazone (Actoplus Met®).
  1. Meglitinides

Examples of medication :

  1. Repaglinide (Novonorm®),
  2. Nateglinide (Starlix®).
  1. Dipeptidyl Peptidase-4 (DPP-4) Inhibitor

Examples of medication :

  1. Sitagliptin (Januvia®),
  2. Vildagliptin (Galvus®),
  3. Saxagliptin (Onglyza®),
  4. Linagliptin (Tradjenta®),
  5. Metformin + Sitagliptin (Janumet®),
  6. Metformin + Vildagliptin (Galvusmet®),
  7. Metformin + Saxagliptin (Kombiglyze XR®).

For every class of medications, there are differents ;

  1. mechanism of action,
  2. administration / how to take, and
  3. adverse reactions.
Class of tablet

&

Examples of medication

Mechanism of Action How to take / Administration Adverse Reactions
 

BIGUANIDES

 

·   Metformin HCl

·   Metformin XR

·   Metformin SR

 

·    Increases sensitivity of cells towards insulin by enhancing peripheral sugar uptake from muscle.

·    Inhibits liver from producing too much sugar.

·    Reduces absorption of sugar in small intestine.

 

 

To be taken after food to avoid adverse reactions.

 

·    Nausea

·    Vomiting

·    Giddiness

·    Diarrhoea

·    Stomach discomfort

·    Headache

·    Skin allergy

 

SULFONYLUREA

 

·   Glibenclamide

·   Gliclazide

·   Gliclazide MR

·   Glimepiride

 

·    Increases production of insulin by the pancreas.

 

To be taken 15-30 minutes before food.

 

·   Low blood sugar (hypoglycaemia)

·   Weight gain

·   Nausea

·   Vomiting

·   Diarrhoea

·   Skin allergy.

 

 

ALPHA-GLUCOSIDASE INHIBITOR

 

·   Acarbose

·   Miglitol

 

·   Inhibits specific enzymes in small intestine thus slowing down digestion and absorption of sugar into blood stream.

 

 

To be chew with first bite of food.

 

·   Bloating

·   Nausea

·   Diarrhoea

·   Fart

 

THIAZOLIDINE-DIONES

 

·  Rosiglitazone

·  Pioglitazone

 

·   Increases insulin sensitivity by activating specific genes which involve in fat formation and metabolism of carbohydrate.

 

To be taken before or after food.

 

·    Fluid retention

·    Weight gain

·    Increase cholesterol (LDL)

·    Increase risk of bone fracture

·    Increase risk of congestive heart failure

 

 

MEGLITINIDES

 

·  Repaglinide

·  Nateglinide

 

·      Increases production of insulin by the pancreas, so it is effective for post-prandial hyperglycaemia.

 

To be taken right before food.

 

·    Low blood sugar (hypoglycaemia)

·    Weight gain

·    Diarrhoea

·    { Giddiness }

·    { Skin allergy }

 

 

DIPEPTIDYL-PEPTIDASE-4 (DPP-4) INHIBITOR

 

·   Sitagliptin

·   Vildagliptin

·   Saxagliptin

·   Linagliptin

 

 

·      Increases production of insulin by the pancreas

·      Reduces glucagon production thus inhibits conversion of glycogen to glucose.

 

To be taken before or after food.

 

·   Nausea

·   Vomiting

·   Diarrhoea

·   Headache

·   Skin allergy.

All of the medications above have to be stored as below :

  1. Keep at room temperature.
  2. Protect from light, heat and moisture.
  3. Keep away from children.

General Advice On Taking Oral Anti-Diabetes

  1. Read the label carefully before taking your medications.
  2. Be compliant in taking your medications.
  3. Inform your healthcare professional if you experience any side effect or problem after taking the medications.
  4. Inform your healthcare professional if you are pregnant or breastfeeding.

References :

  1. Clinical Practice Guidelines Task Force. (2009). Clinical practice guidelines: Management of type 2 diabetes mellitus (4th ed.). Kuala Lumpur: Malaysia. Ministry of Health Malaysia.
  2. Drugs Counseling Guideline Working Committee. (2003). Drugs counseling guide: Endocrine system. Kuala Lumpur: Malaysia. Pharmaceutical Services Division, Ministry of Health Malaysia.
  3. P. O., Knoben. J. E., & Troutman. W.G. (2002). Handbook of clinical drug data (10th ed). New York. U.S. McGraw-Hill.
  4. C. F., Armstrong. L.L., Goldman. M. P., & Lance. L.L. (2008). Drug information handbook (17th ed). Canada. Lexi-Comp, Inc.

 

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