Description
The most effective management of diabetes mellitus demands an interprofessional approach involving both lifestyle modifications with diet and exercise and pharmacologic therapies as necessary to meet individualized glycemic goals. Lifestyle modifications must be combined with oral pharmacologic agents for optimal glycemic control, particularly as type 2 diabetes mellitus progresses with continued loss of pancreatic beta-cell function and insulin production. This activity outlines the indications, mechanisms of action, methods of administration, significant adverse effects, contraindications, monitoring, and toxicity of oral hypoglycemic medications, so providers can direct patient therapy to optimal outcomes where glycemic control and diabetes play a role in outcomes.
Résumé
- The webinar focused on oral anti-diabetic drugs (OADs), now referred to as oral anti-hyperglycemic drugs due to their lower risk of hypoglycemia. The discussion included an overview of OADs, their mechanisms of action, side effects, contraindications, and strategies for improving patient outcomes.
- Biguanides, specifically metformin, were highlighted as a key class of OADs. Metformin activates adenosine monophosphate-activated protein kinase (AMPK), reducing hepatic gluconeogenesis and glucose production. Common side effects include gastrointestinal issues and vitamin B12 deficiency. It should be used cautiously in patients with renal impairment.
- Sulfonylureas (SFUs) were discussed, emphasizing the second-generation SFUs due to fewer adverse effects. SFUs stimulate insulin release from pancreatic beta cells by binding to SUR receptors and reduce serum glucagon concentrations. Hypoglycemia and weight gain are potential side effects.
- Thiazolidinediones (TZDs), such as pioglitazone, decrease insulin resistance by activating PPAR gamma receptors. Pioglitazone can reduce mortality in macrovascular events and improve non-alcoholic steatohepatitis. Contraindications include hepatocellular disease, heart failure, and bladder cancer.
- DPP-4 inhibitors and SGLT2 inhibitors were covered as newer classes of OADs. DPP-4 inhibitors enhance the incretin effect by increasing glucagon-like peptide-1 (GLP-1) levels. SGLT2 inhibitors block glucose reabsorption in the kidneys, leading to glucose excretion in the urine. SGLT2 inhibitors also lower blood pressure and lead to weight loss.
- Alpha-glucosidase inhibitors, such as voglibose, inhibit carbohydrate absorption from the intestine. Glinides, such as repaglinide, are fast-acting insulin secretagogues, effective for managing postprandial hyperglycemia. Common side effects of glinides are hypoglycemia and weight gain.
- The latest ADA guidelines emphasize prioritizing GLP-1 receptor agonists and SGLT2 inhibitors based on the patient's underlying conditions, such as atherosclerotic cardiovascular disease, heart failure, or chronic kidney disease. Metformin remains the first-line drug for patients without these conditions, alongside lifestyle advice.
Exemple de certificat
À propos des intervenants
Dr. Varsha Kachroo
Consultant Endocrinology, Yatharth Super Speciality Hospitals, Delhi
Divulgation financière
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