Type 2 Diabetes: A Summary of Oral Therapy
|
Class of Drug |
Chemical Structure |
Effects |
Toxicity / Side Effects |
Combination Therapy |
| Sulfonylurea | Sulfonic acid-urea nucleus | Increases insulin secretion; reduces HgbA1C 1%-2% as monotherapy; glimepiride may have peripheral insulin-sensitizing effects | Hypoglycemia Glyburide must be used with caution in the elderly or renally impaired patient; glipizide is safer in the elderly patient | Biguanide or thiazolidinediones |
| Biguanide | Structurally distinct from sulfonylureas; dimethylimidodicarbonic compound | Decreases hepatic glucose output; can cause mild weight loss & reduce triglycerides; reduces HgbA1C 1.5%-2% as monotherapy | Risk of lactic acidosis; contra-indicated in patients with renal, hepatic or cardiorespiratory compromise; gastrointestinal irritation | Thiazolidinediones, sulfonylurea, benzoic acid derivative |
| Thiazolidinediones | Thiazolidinedione-α tocopherol compound | Increases peripheral insulin sensitivity; reduces HgbA1C .9% alone and 1.5% on average in combination with insulin; may need 3-4 weeks prior to seeing effects | Hepatotoxicity LFTs must be monitored during therapy; peripheral edema, weight gain | Originally approved for combination therapy with insulin biguanide, sulfonylurea, nylurea, or benzoic acid derivative |
| Benzoic acid derivatives | Benzoic acid compound; some sequence homology to the nonsulfonylurea moiety of glyburide | Increases insulin secretion with meals | Hypoglycemia if tablet is not taken with meals | Biguanide or thiazolidinediones |
| Alpha-glucosidase inhibitors | Oligosaccharide inhibitor of intestinal hydrolases | Blocks intestinal carbohydrate absorption | Gastrointestinal irritation and flatus | Biguanide or thiazolidinediones |