This document provides information on oral agents for diabetic management. It discusses the types of diabetes, targets for treatment, and classes of oral antidiabetic drugs including their mechanisms and side effects. Metformin is recommended as first-line treatment for type 2 diabetes. Sulfonylureas increase insulin secretion but can cause hypoglycemia. Acarbose reduces postprandial glucose levels. Combination therapy or adding basal insulin may help achieve better glycemic control for patients not at target on oral agents alone. Proper use of medication including right drug, dose, administration method and timing is important for effective management of diabetes.
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Oral agents for diabetic management
1. ORAL AGENTS FOR DIABETIC
MANAGEMENT
Prepared by : Cik Hema Latha Sinniah
Pegawai Farmasi U41
Klinik Kesihatan Sungai Besar
2. DIABETES
A chronic metabolic disorder characterised by
a high blood glucose concentration-
hyperglycaemia
fasting plasma glucose > 7.0 mmol/l, or plasma
glucose> 11.1 mmol/l 2 hours after a meal
caused by
insulin deficiency
insulin resistance
3. TARGETS FOR TYPE 2 DIABETES MELLITUS
Glycemic control Levels
Fasting 4.4-6.1 mmol/L
Non fasting 4.4-8.0 mmol/L
HbA1c < 6.5%
Lipids Levels
Triglycerides ≤ 1.7 mmol/L
HDL cholesterol ≥ 1.1 mmol/L
LDL cholesterol ≤2.6 mmol/L
Exercise 150 mins/week
Blood pressure Levels
Normal Renal Function ≤130/80 mmHg
Renal Impairment/Gross Proteinuria ≤125/75 mmHg
4. TYPES OF DIABETES
Type 1 (Juvenile-Onset)
Type 2 (Adult-Onset)
Other types including:
- Gestational diabetes
- MODY (maturity onset diabetes of the young)
- LADA (latent auto-immune diabetes of adults)
- Others
5. CAUSE OF TYPE 1 DM
Auto-immune destruction of
insulin-producing β-cells in
the pancreas
6. CAUSE OF TYPE 2 DM
Insulin resistance (genetics)
- aggravated by obesity
- aggravated by lack of exercise
“Exhaustion” of insulin-producing β-cells
7. MAJOR METABOLIC DEFECTS
IN TYPE 2 DIABETES
Peripheral insulin resistance in
muscle and fat
Decreased pancreatic
insulin secretion
Increased hepatic glucose
output
Haffner SM, et al. Diabetes Care, 1999
8. ORAL ANTIDIABETIC AGENTS:
Agents that are given orally to reduce the
blood glucose levels in diabetic patients
Five types of oral antidiabetic drugs are
currently in use:
• Biguanides :metformin
• Sulfonylureas: glimepiride, gliclazide,
glyburide, tolbutamide, glibenclamide,
glipizide
• Meglitinides : nateglinide, repaglinide
• Thiazolidinediones : pioglitazone,
rosiglitazone
Alpha -glucosidase inhibitors: acarbose,
miglitol
9. The oral antidiabetic drugs are of value only in the treatment
of patients with type 2 (NIDDM) diabetes mellitus whose
condition cannot be controlled by diet alone.
These drugs may also be used with insulin in the management
of some patients with diabetes mellitus, Use of an oral
antidiabetic drug with insulin may decrease the insulin dosage
in some individuals.
10. METFORMIN (BIGUANIDES)
does not stimulate insulin secretion
increase glucose uptake and utilisation in skeletal
muscle (thereby reducing insulin resistance) and
reduce hepatic glucose production (gluconeogenesis).
First line drug treatment in overweight/obese
patients.
will lower HbA1c by about 1.5%.
Usually not accompanied by hypoglycemia
11. Contra indications
-Metformin should not be given to patients with
Renal failure
Hepatic disease
Hypoxic pulmonary disease
Heart failure or shock
12. GLIBENCLAMIDE AND GLICLAZIDE
(SULFONYLUREAS)
Works by increasing insulin secretion.
can lower plasma glucose by up to 25%
lower HbA1c by about 1.5%.
SUs should be taken 30 minutes before meals
Combining two different sulfonylurea is not
recommended
Long acting sulfonylurea (i.e Glibenclamide)
associated with greater risk of hypoglycemia.
13. ACARBOSE -ALPHA-GLUCOSIDASE INHIBITOR
(AGI)
Act at the gut epithelium, to reduce the rate of
digestion of polysaccharides in small intestine.
primarily lower postprandial glucose without causing
hypoglycemia
Patients receiving insulin or SUs as well as acarbose
need to carry glucose to counteract possible
hypoglycemia.
Need to be taken together with food.
14. BEFORE INITIATING INSULIN:
Before considering to start patient on
insulin, there are a few points that needs to
be considered:
Patient’s compliance towards current
medication
Patient’s age
Patient’s other comorbidities
Patient’s diet control and lifestyle
Patient’s agreement
26. CARA PENGAMBILAN
BENTUK
DOSEJ
CARA PENGAMBILAN
MIXTURE/
SYRUP
MINUM SEPERTI DIARAHKAN
LOTION/ KRIM SAPU PADA TEMPAT YANG
MENGALAMI MASALAH SAJA
SEPERTI DIARAHKAN
SUPPOSITORI MASUKKAN KE DALAM DUBUR
SEPERTI DIARAHKAN
INHALER /
TURBOHALER
GUNAKAN MENGIKUT TEKNIK
YANG BETUL
TABLET/
KAPSUL
TELAN. JANGAN KUNYAH ATAU
HANCURKAN JIKA TIDAK
DIARAHKAN.
28. SEKALI
SEHARI SETIAP 24JAM
WAKTU YANG SAMA
SETIAP HARI. MALAM @
SIANG
2 KALI
SEHARI SETIAP 12JAM CTH: 8 PAGI, 8 MALAM
3 KALI
SEHARI SETIAP 8JAM
CTH: 6 PAGI, 2 PETANG,
10 MALAM
4 KALI
SEHARI SETIAP 6JAM
CTH: 6 PAGI, 12 TGH, 6
PTG, 12 MLM
BILA
PERLU
DIAMBIL BILA DIPERLUKAN
SAJA
CTH: BILA SAKIT, BILA ADA
SERANGAN ASTHMA
MASA PENGAMBILAN/
PENGGUNAAN UBAT