Types of Diabetes Type I And II Medications

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What are the types of diabetes type II medications?

Medications and their dosages for type II diabetes are individualized based on the patient’s stage of diabetes and their response to the medication. Different medications work in different ways to maintain optimum blood glucose levels. Types of type II medications include:

  • Biguanides
  • Sulfonylureas
  • Meglitinide derivatives
  • Alpha-glucosidase inhibitors
  • Thiazolidinediones (TZDs)
  • Glucagonlike peptide–1 (GLP-1) agonists
  • Dipeptidyl peptidase IV (DPP-4) inhibitors
  • Selective sodium-glucose transporter–2 (SGLT-2) inhibitors
  • Insulins
  • Amylinomimetics
  • Bile acid sequestrants
  • Dopamine agonists

How do type II diabetes medications work?

Biguanides

Biguanides reduce the glucose levels in three ways:

  • Improve body’s response to natural insulin
  • Reduce glucose absorption from the intestines
  • Decrease glucose production by liver

The only biguanide currently available in the US is:

Sulfonylureas

Sulfonylureas stimulate insulin production by the pancreas. Sulfonylureas include:

Meglitinides

Meglitinides also stimulate insulin production, but are short-acting and typically taken before a meal. Meglitinides include:

Alpha-glucosidase inhibitors

Alpha-glucosidase inhibitors delay the absorption of carbohydrates and sugars, and prevent the sugar spike after a meal. Alpha-glucosidase inhibitors include:

Thiazolidinediones (TZDs)

Thiazolidinediones sensitize the body to respond better to insulin. It may be used as monotherapy if the patient’s pancreas produces sufficient insulin, or in combination with other medications. TZDs are the only type of antidiabetic medication which has been shown to be effective in slowing down the progression of diabetes, particularly in early stages of the disease.

TZDs include:

Glucagonlike peptide–1 (GLP-1) agonists

Glucagonlike peptide–1 (GLP-1) agonists boost GLP-1 activity. (GLP-1) is a hormone known as incretin, which is secreted immediately after eating when glucose level rises. GLP-1 stimulates postprandial release of insulin, reduces glucagon and slows gastric emptying. GLP-1 agonists include:

Dipeptidyl peptidase IV (DPP-4) inhibitors prolong the activity of incretins to stimulate release of insulin. DPP-4 is an enzyme produced in the body to degrade incretins such as GLP-1 and glucose-dependent insulinotropic polypeptide (GIP). DPP-4 inhibitors include:

Selective sodium-glucose transporter–2 (SGLT-2) inhibitors

Selective sodium-glucose transporter–2 (SGLT-2) inhibitors reduce glucose level by increasing its excretion in the urine. SGLT-2 inhibitors include:

Bile acid sequestrants

Bile acid sequestrants were developed to lower cholesterol in the blood, but were also found to lower glucose. The effect, however, is not significant, and the way they work is unclear. Bile acid sequestrants may be prescribed as an adjunct therapy for diabetes, or to lower LDL cholesterol in people with prediabetes.

Bile acid sequestrants, as a rule, are not prescribed for high triglycerides, another kind of blood fat. The FDA-approved bile acid sequestrant as adjunct therapy for diabetes is:

Dopamine receptor agonists

Dopamine is a chemical (neurotransmitter) released by the hypothalamus in the brain. It is not clear how dopamine agonists work in reducing glucose, but when given in a single, timed morning dose, they appear to reduce the abnormal elevation in glucose and fatty acids, in insulin-resistant patients.

Dopamine agonists may be useful for obese patients who require minimal reduction of sugar levels and do not tolerate other diabetes medications. The FDA-approved dopamine agonist is a quick release formulation of:

Amylinomimetics

Amylinomimetics are synthetic analogs of the human amylin, a hormone secreted by pancreas, which lowers glucose. Other than insulin, amylinomimetics are the only antidiabetic medication prescribed for type I diabetes also. The only available amylinomimetic in the US is:

  • Pramlintide acetate (Symlin) injection

Insulins

While insulin is the mainstay treatment for type I diabetes, it is used for treating type II diabetes when the glucose levels cannot be managed with diet, weight loss, exercise and oral medications. For some people insulin therapy may be used for a short period to bring down acute elevation in glucose levels.

Most type II diabetes patients ultimately become insulin-deficient with the progression of disease, and will require insulin therapy. Many type II diabetes patients also develop insulin resistance, so insulin therapy is individualized based on each patient’s condition.

Combination medications

Combination medications available for type II diabetes include:

  • Glyburide/metformin
  • Glipizide/metformin (Metaglip)
  • Pioglitazone/metformin (Actoplus Met, Actoplus XR)
  • Pioglitazone/glimepiride (Duetact)
  • Alogliptin/metformin (Kazano)
  • Alogliptin/pioglitazone ((Oseni)
  • Canagliflozin/metformin (Invokamet)
  • Dapagliflozin/metformin (Xigduo XR)
  • Sitagliptin/metformin (Janumet, Janumet XR)
  • Saxagliptin/metformin (Kombiglyze, Kombiglyze XR)
  • Linagliptin/metformin (Jentadueto)



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