There are many different types of oral medications available to treat type 2 diabetes. A majority of the drugs can be combined to produce a more effective treatment strategy, however the medications are often more effective when patients manage their glucose intake. Type 2 diabetes is caused by insulin resistance by cells which results in the body's inability to absorb glucose. Therefore, treatment strategies are usually geared towards increasing the amount of insulin produced by the pancreas, increasing the sensitivity of the cells that are targeted by insulin and by modifying the rate at which glucose is absorbed in the gastrointestinal tract.
Medical Nutritional Therapy (MNT)
For patients with mild or no related symptoms, MNT is emphasized. This treatment strategy requires giving the patient dietary adjustments that can help lead lower blood glucose levels. Besides nutritional plans, the strategy includes patient education, where patients are taught strategies to self-manage. If MNT fails, then the patient is considered a candidate for the oral medications.
Diabetic Oral Medications
Medications are usually combined with MNT. In some cases oral medications can be combined with titrations of intravenous insulin.
- Sulfonylureas: These medications act by stimulating the pancreas to release more glucose. They are used mainly with patients who have residual beta cell function. These agents include glipizide and glyburide.
- Biguanides: These agents act by increasing insulin’s ability to absorb glucose into the cells and also by decreasing gluconeogenesis in the liver. This class includes metformin.
- Thiazolidinediones: This class of drugs acts by sensitizing the insulin receptors. They can be used alone or in conjunction with some of the other anti-diabetic agents. Rosiglitazone (Avandia) and Actos are examples of drugs in this class.
- Meglitinides: Meglitinides act on the ATP-dependent channels in the pancreatic beta cells. They open the channels which then leads to increased insulin release. This class includes drugs like repaglinide and nateglinide.
- Alpha-glucosidase inhibitors: This class acts by blocking the digestion of sugars. The sugars end up in the colon where they are converted to short chain fatty acides, hydrogen and methane. These include medications such as acarbose and miglitol.
- Dipeptidyl Peptidase IV (DPP-4) Inhibitors: This class of medications works by increasing the release of insulin and suppressing glucagon secretion. They include agents such as sitagliptin and saxagliptin.
- Combination Therapies: Some diabetic pills are a combination of two agents. An example of these combination medications is Avandamet which is a combination of rosiglitazone (Avandia) and metformin.
Advances in Oral Diabetic Medications
There are still potential new anti-diabetic medications under investigation. Imeglimin is an example of one of the drugs that is still undergoing clinical trials. It represents a new class of anti-diabetic drugs. These new drugs are designed to inhibit glucose synthesis in the liver, increase glucose uptake and work on restoring insulin secretion.
Sources
"POXEL - Imeglimin Is a First in Class Anti-diabetic Product Directly Acting on 3 Different Target Organs." POXEL - Pharmaceutical Company Set-up to Find Innovative Solutions for Metabolic Diseases Management with a Primary Focus on Type 2 Diabetes. Web. 04 Aug. 2010. .
"Diabetes Mellitus, Type 2 - A Review: Treatment & Medication - EMedicine Emergency Medicine." EMedicine - Medical Reference. 29 Jan. 2010. Web. 03 Aug. 2010. .
