Diabetes Treatment
Type 2 Diabetes
Metformin
Sulfonylureas
 Gliclazide
 Glipizide
 Glimepiride
 Glibenclimide
Thiazolidinediones
 Pioglitazone
 Rosiglitazone
Acarbose
GLP-1 analogues
(Incretin based therapies)
 Exenatide (BD or
Weekly)
 Liraglutide (QD)
 Dulaglutide (Weekly)
DPP 4 inhibitors
(Incretin based therapies)
 Sitagliptin
 Vildagliptin
 Saxagliptin
 Linagliptin
SGLT-2 inhibitors
 Dapagliflozin
 Canagliflozin
 Empagliflozin
Liraglutide associated with reduced cardiovascular outcomes in long-term (LEADER) trial.
 Decreases glucose output from  First choice treatment
glycogen storage in the liver  No effect on weight
 Increases insulin sensitivity by  No hypoglycemia
increasing glucose uptake  Contraindications:
- Renal impairment (lactic acidosis)
 Side effects:
- GI upset
 Stimulate beta cells to release  Second choice treatment
insulin.  Contraindications:
- Obesity
 Side effects:
- Risk of hypoglycemia
- Weight gain
 Increase insulin sensitivity in  No hypoglycemia
adipose tissue and muscles by  Side effects:
binding to peroxisome - Weight gain
proliferator activated - Oedema
receptors (PPAR)-gamma & - Increase risk of fractures
regulating gene expression.
 Disaccharide inhibitor that  Least effective drug
delays absorption of glucose  Side effect:
after meals. - GI upset
 GLP – 1 is a peptide release  Injected once or twice day
from the small intestine in  No hypoglycemia
response to glucose absorption.  Weight loss (can be used for obese
 Drug activates GLP-1 receptors patient)
to increase insulin secretion  Side effects:
and decrease glucagon - Nausea
secretion. - Injection site reaction
 Act in pancreas. - Pancreatitis
 DPP 4 is an enzyme that breaks  Injected
down GLP-1.  No hypoglycemia
 Drug binds to DPP 4 and  No weight gain
inhibits its action increasing the  Side effect:
half-life of GLP-1. - Increase risk of cardiovascular
 Act in pancreas. problems in the long term
 SGLT-2 is transporter in  Side effects:
nephron that allows glucose - Weight loss
reabsorption - Decrease blood pressure
 Drug inhibits SGLT2 in kidney. - Increase risk of genital and urinary
tract infection
 NB:
α-glucosidase inhibitors act in stomach.
Biguanides act in liver\meglintides act in pancreas.

Indications for Insulin in Type 2 Diabetes

 Not meeting glycemic targets on maximum doses of OHAs
 Decompensation during intercurrent illness, eg infection, injury
 Uncontrolled weight loss
 Perioperative in patients undergoing surgery
 Pregnancy
 Hepatic or renal disease
 Allergy or other serious reaction to oral agents
 Latent autoimmune diabetes in adults (LADA)
 Relief of glucose toxicity

Management of Type 1:
 Monitoring glycemic control – finger prick, symptoms, HbA1c, blood ketone level.
 Lifestyle modification
 Insulin replacement – subcutaneous insulin or Islet replacement therapies
 Involvement of multi-disciplinary team

Type 1 Diabetes
Basal – Bolus Insulin  Basal/Nighttime insulin: suppresses  Injected
glucose production between meals  Side effects:
Basal: and overnight. (long term & provides - Hypoglycemia
 Glargine 50% of daily requirement) - Weight gain
 Detemir - Oedema
 Bolus/Mealtime insulin: limits - Allergy
Bolus: hyperglycemia after meals (short
 Glulisine term & provides 10% of daily
 Aspart requirement)
 Lispro/Humalog

Insulin pump  Mimics normal pancreas function  Injected

 Costly
 Side effects:
- Hypoglycemia
- Weight gain
- Oedema
- Allergy
- Infection
- Ketoacidosis

In type 1 DM; intensive glucose control (as opposed to cultural) has a greater effect on reducing retinopathy,
neuropathy and nephropathy.