Introduction: The treatment of type 2 diabetes includes diet, modification of lifestyle and oral hypoglycemic therapy. The major aims are not only to reduce the weight of obese patient and improve glycemic control but also to reduce the risk of cardiovascular disease, reduce adverse effects and improve compliance.
Role of oral anti diabetic agent therapy in type 2diabetes mellitus
Oral antidiabetic agents (OADs) follow diet and exercise in the management in an individual with frank diabetes mellitus. While trying to use OADs in the control of diabetes mellitus.
People with type 2 diabetes should be told at the onset that type 2 diabetes is a progressive disease and that eventually even with attention to diet and exercise their bodies will not make enough insulin. When this happens, they will have to start a medication that will help them release more insulin or help their insulin to work better. While trying to use OADs in the control of Diabetes mellitus, one should also try and attempt to:
1. To conserve islet cell function and thereby delay subsequent use if insulin
2.Decrease the prevalence of hypoglycemic episodes
3.Improve patient compliance with medication (attempting to reduce the frequency of dosing)
4 Considering the cost factor when the affordability of the patient comes into play.
5. Achieve the best possible blood glucose levels in order to prevent or delay the development of complication such as:
Cardiovascular disease and stroke
Retinopathy,NephropathyNeuropathyPeripheral vascular disease
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Position statement in diabetes book
Page 155 and 156
Expected effect of blood glucose- lowering therapies when use as mono therapy:
For instance , if a person is started on metformin( biguanide alone, you could expect their HbA1c to drop only about 1.5%
The action of the blood glucose – lowering medications:
There are different groups of insulin secretagogues. The most comman and the ones that have been around the longest are the sulphonylures. They work primarily by stimulating pancreatic insulin secretion, which in turn reduce hepatic glucose out our and increases peripheral glucose disposal.
There are many medication in this group; some familiar names are glibenclamide, gliclazide, and glimeperide. The timing and action differ for each of these.
Table 2: sluphonylureas
Meglitinides are also insulin secretagogues . They work faster and last a shorter time than the sulphonylures . They are usually given before a meal to primate the secretion of insulin to cover the rise in blood glucose related to the carbohydrate eaten
Metformin decrease glucose production in the liver( glycogenolysus)
Metformin may increase glucose utilisation in peripheral tissues somewhat, by decreasing insulin resistance in muscle cells.
Buduanides has been used as the first-line of treatment after lifestyle changes for people who are overweight or obese.metformin is effective in approximately 75-80 % of patients who take it as a monotherapy has been shown
to reduce HbAlc by approximately 1.5%
3. Thiazolidinediones: they increase
Insulin sensitivity by increasing peripheral uptake of glucose in muscle and adipose tissue. They also lower hepatic glucose production to a lesser extent and stimulate oxidation and lipogenesis on adipose tissue.
Side effects: weight gain is associated with the TZDs. People often gain some weight