Oral hypoglycemic agents

Article Abstract:

Diabetes mellitus is a disorder of sugar intolerance caused by a lack of the hormone insulin. For some patients insulin must be administered to maintain life. In patients with non-insulin-dependent diabetes mellitus (NIDDM), the production of insulin is impaired either by obesity or a defect in insulin secretion. Therapy should restore the insulin-sugar imbalance with insulin or oral hypoglycemic agents to lower the amount of blood sugar. Patients can lose weight, exercise and take a variety of drugs to return to adequate sugar control. For patients who cannot adequately control sugar through diet and exercise, oral agents are available. Sulfonylureas are a class of drugs which work to stimulate the release of insulin. Four commonly prescribed sulfonylureas are tolbutamide, acetohexamide, tolazamide and chlorpropamide, which differ in duration of action and potency. Lipid or fat metabolism may be altered by these sulfonylureas by reducing the amount of high and low density lipoprotein cholesterol in the blood. High cholesterol has been associated with the development of atherosclerosis. This is of some concern since patients with diabetes already have compromised lipid metabolism and are at risk for vascular disease. The drugs have few side effects, which are experienced by less than two percent of those taking the drug. These side effects include low sodium which can cause water retention and weight gain and low glucose, hypoglycemia. Both these side effects are more common in patients over the age of 60. Some patients may benefit from a combination of insulin therapy and sulfonylurea therapy. Another type of oral hypoglycemic agent is biguanides, which are not currently used in the United States. Metformin, available in Canada, is currently being tested for use in the US. It does not have the side effects found in sulfonylureas and has similar ability to control sugar. Side effects associated with metformin are loss of appetite, nausea, diarrhea and intestinal discomfort, and are usually temporary. Another drug, acarbose, is also being tested for use in the US. This drug improves the effectiveness of insulin by delaying the absorption of carbohydrates.

Analysis, Evaluation, Hypoglycemic agents, column, Biguanide, Hypoglycemic sulphonylureas

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Metformin

Article Abstract:

Metformin appears to be a useful new oral medication for reducing blood sugar levels in noninsulin-dependent diabetics. Derived from an herb used to treat diabetes in medieval times, metformin has long been available in Europe. However, until recently, sulfonylureas have been the only oral medications for treating high blood sugar approved in the U.S. Metformin acts to help insulin work more effectively, thereby increasing sugar uptake primarily in muscle cells but also in fat cells. Unlike the sulfonylureas or insulin, metformin does not lead to weight gain or cause low blood sugar. Metformin is contraindicated in patients with kidney or liver dysfunction or in persons with illnesses causing oxygen lack or poor peripheral circulation. Side effects include diarrhea, mild abdominal pain, lack of appetite, or nausea, but symptoms usually abate when the dosage is reduced. Only about 5% of patients cannot tolerate the drug.

Health aspects, Metformin

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