Endocrinology Book

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Oral Hypoglycemic

Aka: Oral Hypoglycemic, Oral Medications for Type 2 Diabetes
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  1. Agents: Most effective
    1. Obese patients
      1. Thiazolidinediones (e.g. Rosiglitazone)
      2. Metformin (Glucophage)
    2. Lean patients
      1. Sulfonylurea or other secretagogue
  2. Agents: Available
    1. General
      1. Lifestyle changes can lower A1C by 1-2%
      2. Efficacy Example: Weight loss, diet and Exercise
        1. Pre-intervention: HBA1C is 10%
        2. Post-intervention: HBA1C might drop to 8-9%
      3. Insulin is very cost effective (consider early)
        1. Lowers HBA1C an unlimited amount
        2. Can be used with Insulin Resistance agents
          1. Thiazolidinediones (e.g. Rosiglitazone)
          2. Metformin (Glucophage)
        3. Cost (monthly)
          1. Basal Insulins: NPH ($25) or Lantus ($80)
          2. Bolus Insulins: Regular ($35) or Lispro ($85)
    2. Insulin Secretagogues (early Type II Diabetes)
      1. Older agents (rarely used in United States)
        1. Chromium Picolinate
        2. First Generation Sulfonylurea (e.g. Tolbutamide)
      2. Newer Agents
        1. Second Generation Sulfonylurea (e.g. Glipizide)
          1. Cost: $11 per month
          2. Lowers HBA1C by 1.5%
        2. Meglitinides (e.g. Nateglinide, Repaglinide)
          1. Lowers HBA1C by 1.5%
    3. Insulin Resistance Agents
      1. Biguanides (e.g. Glucophage)
        1. Decreases hepatic Glucose release
        2. Lowers HBA1C by 1.5%
        3. Cost: $45 per month
      2. Thiazolidinediones (e.g. Rosiglitazone)
        1. Increases muscle and fat Insulin sensitivity
        2. May also independently reduce cardiovascular risk
        3. Lowers HBA1C by up to 1.4%
        4. Cost: $180 per month
      3. Alpha-glucosidase Inhibitors (e.g. Acarbose)
        1. Decreases gastrointestinal carbohydrate absorption
        2. Lowers HBA1C by 0.5 to 1%
    4. Combination agents
      1. Glucophage and Insulin secretogogue (e.g. Glucovance)
      2. Thiazolidinediones with Insulin secretogogue
      3. Basal Insulin (e.g. Lantus) with Glucophage
        1. Cost: $125/month
        2. Contrast Glucophage + Glitizone + Glipizide: $300
      4. Insulin with Glucophage and Glitazone
  3. Protocol: Sample Template for Prescribing Combination Oral Agents
    1. General
      1. Use a combination of agents (consider from onset)
      2. Treat Insulin Resistance and Insulin shortage
    2. Example of Oral Hypoglycemic regimen for obese patient
      1. Initial Management: Decrease hepatic Glucose release
        1. Glucophage (Metformin)
      2. Next Management: Insulin Secretion
        1. Recent onset Type II Diabetes: Sulfonylurea
        2. Prolonged Type II Diabetes: Consider Insulin
      3. Next Management: Insulin Resistance
        1. Thiazolidinediones (e.g. Rosiglitazone) or
        2. Alpha-glucosidase Inhibitor: (e.g. Acarbose)
    3. Example of Oral Hypoglycemic regimen for lean patient
      1. Initial Management: Insulin Secretion
        1. Recent onset Type II Diabetes: Sulfonylurea
        2. Prolonged Type II Diabetes: Consider Insulin
      2. Next Management
        1. Alpha-glucosidase Inhibitor: (e.g. Acarbose)
    4. Examples based on timing of Hyperglycemia
      1. Pre-meal fasting Hyperglycemia
        1. Sulfonylurea (most effect is on pre-meal Glucose)
        2. Insulin Resistance agents
          1. Glucophage (Metformin)
          2. Thiazolidinediones (e.g. Rosiglitazone)
      2. Postprandial Hyperglycemia (Insulin deficiency)
        1. Meglitinides (e.g. Repaglinide)
        2. Alpha-glucosidase Inhibitors
  4. Adverse Effects: Oral Agents
    1. Hypoglycemia
      1. Associated with Diabetics on ACE Inhibitors
      2. Higher risk with Captopril than Enalapril
      3. Higher risk for Sulfonylureas
      4. May account for 14% DM admissions for Hypoglycemia
    2. Weight gain
      1. Sulfonylureas
    3. Gastrointestinal side effects
      1. Biguanides (Glucophage)
      2. Alpha-glucosidase Inhibitors (Acarbose, Miglitol)
    4. Lactic Acidosis
      1. Biguanides (Glucophage)
    5. Liver toxicity
      1. Thiazolidinediones (e.g. Actos or Avandia)
    6. Edema (avoid in Congestive Heart Failure)
      1. Thiazolidinediones (e.g. Actos or Avandia)
  5. References
    1. Luna (2001) Am Fam Physician 63(9):1747-56
    2. Yki-Jarvinen (2001) 24:758-67

Hypoglycemic Agents (C0020616)

Definition (MEDLINEPLUS)

Diabetes means your blood glucose, or blood sugar, is too high. If you can't control your diabetes with wise food choices and physical activity, you may need diabetes medicines. The kind of medicine you take depends on your type of diabetes, your schedule, and your other health conditions.

With Type 1 diabetes, your pancreas does not make insulin. Insulin is a hormone that helps glucose get into your cells to give them energy. Without insulin, too much glucose stays in your blood. If you have type 1 diabetes, you will need to take insulin.

Type 2 diabetes, the most common type, can start when the body doesn't use insulin as it should. If your body can't keep up with the need for insulin, you may need to take pills. Some people need both insulin and pills. Along with meal planning and physical activity, diabetes pills help people with type 2 diabetes or gestational diabetes keep their blood glucose levels on target. Several kinds of pills are available. Each works in a different way. Many people take two or three kinds of pills. Some people take combination pills. Combination pills contain two kinds of diabetes medicine in one tablet. Some people take pills and insulin.

NIH: National Institute of Diabetes and Digestive and Kidney Diseases
Definition (MSH) Substances which lower blood glucose levels.
Definition (CSP) class of agents which lower blood glucose levels.
Concepts Pharmacologic Substance (T121)
MSH D007004
SnomedCT 325290009, 373299009, 9356005, 312064005
English Agents, Hypoglycemic, Hypoglycemic Agents, hypoglycemic agent, Hypoglycemic agents, Drugs, Hypoglycemic, Hypoglycemic Drugs, Hypoglycemic drug, Hypoglycemics, Drugs for hypoglycaemia, Drugs for hypoglycemia, Hypoglycemic drug, NOS, Hypoglycaemic drug, NOS, Drugs for hypoglycemia (product), antihyperglycemic, Hypoglycaemic drug, Anti-hyperglycemics, hypoglycemic drugs, hypoglycemic agents, hypoglycaemic, hypoglycemic, hypoglycemic drug, Diabetes Medicines, Hypoglycemic Medicines, Agents, Antihyperglycemic, Antihyperglycemic Agents, Antihyperglycemics, Hypoglycaemic, Hypoglycemic agent (substance), Hypoglycemic, Hypoglycaemic agent, Hypoglycemic agent, Hypoglycaemic product, Hypoglycemic agent (product), Hypoglycemic product, Drugs for hypoglycemia (substance), Hypoglycemic drug (substance), Hypoglycemic product (product)
French Agents hypoglycémiques, Agents hypoglycémiants, Médicaments hypoglycémiants, Médicaments hypoglycémiques, Hypoglycémiants
Swedish Hypoglykemiska medel
Spanish fármacos para el tratamiento de la hipoglucemia, fármacos para el tratamiento de la hipoglucemia (producto), agente hipoglucemiante (sustancia), agente hipoglucemiante, droga hipoglucemiante (producto), droga hipoglucemiante (sustancia), droga hipoglucemiante, fármaco hipoglucemiante (producto), fármaco hipoglucemiante, hipoglucemiante (producto), hipoglucemiante, Agentes Hipoglucemicos, Agentes Hipoglucémicos
Czech hypoglykemika
Finnish Verensokeria alentavat aineet
Italian Ipoglicemici, Farmaci ipoglicemici, Sostanze ipoglicemiche
Russian PROTIVODIABETICHESKIE SREDSTVA, ANTIDIABETICHESKIE SREDSTVA, GIPOGLIKEMICHESKIE SREDSTVA, АНТИДИАБЕТИЧЕСКИЕ СРЕДСТВА, ГИПОГЛИКЕМИЧЕСКИЕ СРЕДСТВА, ПРОТИВОДИАБЕТИЧЕСКИЕ СРЕДСТВА
Japanese 血糖降下薬, 経口抗糖尿病薬, 抗糖尿病薬, 糖尿病薬, 糖尿病治療剤, 抗糖尿病剤, 血糖降下剤, 経口血糖降下薬
Croatian ANTIDIJABETICI
Polish Leki hipoglikemizujące, Czynniki hipoglikemizujące, Środki przeciwcukrzycowe, Środki hipoglikemiczne
German Blutzuckersenkende Mittel
Portuguese Hipoglicêmicos
Sources
Derived from the NIH UMLS (Unified Medical Language System)


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