Anti Diabetic

Drugs used in diabetes treat diabetes mellitus by lowering the glucose level in the blood. With the exceptions of insulin, exenatide, liraglutide and pramlintide, all are administered orally and are thus also called oral hypoglycemic agents or oral antihyperglycemic agents. There are different classes of anti-diabetic drugs, and their selection depends on the nature of the diabetes, age and situation of the person, as well as other factors.



Diabetes mellitus type 1 is a disease caused by the lack of insulin. Insulin must be used in type 1, which must be injected. Diabetes mellitus type 2 is a disease of insulin resistance by cells. Type 2 diabetes mellitus is the most common type of diabetes. Treatments include (1) agents that increase the amount of insulin secreted by the pancreas, (2) agents that increase the sensitivity of target organs to insulin, and (3) agents that decrease the rate at which glucose is absorbed from the gastrointestinal tract.

Several groups of drugs, mostly given by mouth, are effective in type 2, often in combination. The therapeutic combination in type 2 may include insulin, not necessarily because oral agents have failed completely, but in search of a desired combination of effects. The great advantage of injected insulin in type 2 is that a well-educated patient can adjust the dose, or even take additional doses, when blood glucose levels measured by the patient, usually with a simple meter, as needed by the measured amount of sugar in the blood.

Overview of Anti Diabetes Drugs:

Biguanide (metformin) :

Action: Enhances the effect of insulin.

Side Effect:  Lactic Acidosis, Weight loss, Gastrointestinal complaints are common (e.g. diarrhea, abdominal cramps), Reduced vitamin B12 absorption.

Contraindications: Chronic Kidney Disease, Liver Failure, Metformin must be paused before administration of iodinated contrast medium and major surgery.

Sulfonylureas (e.g., glyburide, glimepiride):

Action: Increase insulin secretion from pancreatic β-cells

Side Effect: Risk of hypoglycemia, Weight gain, Hematological Changes: agranulocyrosis, hemolysis.

Contraindications: Severe cardiovascular comorbidity, Obesity, Sulfonamide allergy.

 Mwglitinides (nateglinide, repaglinide):

Action: Increase insulin secretion from pancreatic β-cells

Side Effect: Risk of hypoglycemia, Weight gain

Contraindications:  Severe renal or liver failure

DPP-4 inhibitors (saxagliptin, sitagliptin):

Action: Inhibit GLP-1 degradation → promotes glucose-dependent insulin secretion

Side Effect:Gastrointestinal complaints, Pancreatitis,Headache, dizziness, Arthralgia

Contraindications: Liver failure, Moderate to severe renal failure

SGLT-2 inhibitors (canagliflozin, dapagliflozin, empagliflozin):

Action: Increased glucosuria through the inhibition of SGLT-2 in the kidney.

Side Effect:Genital yeast infections and urinary tract infections
Polyuria and dehydration, Diabetic ketoacidosis

Contraindications:Chronic kidney disease, Recurrent urinary tract infections.

GLP-1 agonists (incretin mimetic drugs: exenatide, liraglutide, albiglutide):

Action: Direct stimulation of the GLP-1 receptor

Side Effect: Nausea, Increased risk of pancreatitis and possibly pancreatic cancer

Contraindications: Preexisting, symptomatic gastrointestinal motility disorders.

Alpha-glucosidase inhibitors (acarbose):

Action: Reduce intestinal glucose absorption

Side Effect: Gastrointestinal complaints (flatulence, diarrhea, feeling of satiety)

Contraindications: Any preexisting intestinal conditions (e.g., inflammatory bowel disease), Severe renal failure

Amylin analogs (pramlintide):

Action: Reduce glucagon release, Reduce gastric emptying,Increase satiety

Side Effect: Risk of hypoglycemia, Nausea

Contraindications: Gastroparesis

Thiazolidinediones (pioglitazone):

Action: Reduce insulin resistance through the stimulation of PPARs (peroxisome proliferator-activated receptors), Increase transcription of adipokines

Side Effect: Weight gain, Edema, Cardiac failure, Increased risk of bone fractures (osteoporosis)

Contraindications: Liver failure, Congestive heart failure.