Treatment of diabetes Mellitus T2 from

view point of cardiology link

Samir Rafla
Emeritus professor of Cardiology,
Alexandria University, Faculty of Medicine,
Cardiology Department. Egypt.
Management of type 2 diabetes includes:

- Weight loss

- Healthy eating

- Regular exercise

- Blood sugar monitoring

- Possibly, diabetes medication or insulin therapy

• These steps will help keep your blood sugar level closer to normal, which can
delay or prevent complications. Weight loss:

1 Losing weight can lower your blood sugar levels. Losing just 5 to 10 percent of
your body weight can make a difference.

2 Healthy eating: Contrary to popular perception, there's no specific diabetes

diet. However, it's important to center your diet around:

• Fewer calories. Fewer refined carbohydrates, especially sweets

• Fewer foods containing saturated fats

• More vegetables and fruits. More foods with fiber

• 3 Physical activity: Aim for at least 30 to 60 minutes of moderate (or
15 to 30 minutes of vigorous) aerobic exercise most days of the
week. Remember that physical activity lowers blood sugar. It's also
important to reduce the amount of time you spend in inactive
activities, such as watching TV. Try to move around a bit every 30
minutes.

• 4 Monitoring your blood sugar:

• 5 Diabetes medications and insulin therapy

 • Oral Drugs for Diabetes:
• Each class of medicine works in different ways to lower blood
sugar. A drug may work by:
• Stimulating the pancreas to produce and release more insulin
• Inhibiting the production and release of glucose from the liver
• Blocking the action of stomach enzymes that break down
carbohydrates
• Improving the sensitivity of cells to insulin
• Inhibiting the reabsorption of glucose in the kidneys
 • Biguanides
• Medications: Metformin (Glucophage, others)
• Action: Inhibit the release of glucose from the liver, Improve
sensitivity to insulin
• Advantages: Very effective, May promote modest weight loss, Low
cost
• Possible side effects: Nausea, Diarrhea,
Very rarely, the harmful buildup of lactic acid (lactic acidosis) when
used in patients with kidney or liver failure.
Sulfonylureas. These medications help your body secrete more insulin.
Medications
 Glipizide
 Gliclazise (Diamicron)
 Glimepiride (Amaryl, Glimet, Glaryl, Dolcyl)
 Glyburide , Glibeneclamide ( Daonil )
Action
 Stimulate the release of insulin
Advantages
 Low cost
 Effective in lowering blood sugar
 
Possible side effects: Hypoglycemia,
 Weight gain; Skin rash
 Thiazolidinediones
Medications: Pioglitazone (Actos)
Action: Improve sensitivity to insulin
 Inhibit the release of glucose from the liver
Advantages
 May slightly increase high-density lipoprotein (HDL), or "good"
cholesterol
Possible side effects
 Weight gain, Heart failure, Heart attack
 Fractures, Possible increased risk of bladder cancer with pioglitazone
These medications shouldn't be used in people with kidney disease or heart
problems.
 Meglitinides. 

These medications — such as repaglinide (Gluconorm,

Novonorm – Novo Nordisk- 0.5, 1, 2 mg tablets ) and
Nateglinide (Starlidine 60, 120 mg ) — work like
sulfonylureas by stimulating the pancreas to secrete
more insulin, but they're faster acting.
 DPP-4 inhibitors. Dipeptidyl-peptidase 4 (DPP-4) inhibitors
Medications:
- Vildagliptin (Galvus, Galvus met, Vildagluse, Vildagluse plus,
Icandra)
- Saxagliptin (Onglyza, )
- Sitagliptin (Januvia)
- Linagliptin (Tradjenta, Linajenta 5 mg)
- Alogliptin
Action
 Stimulate the release of insulin when blood glucose is rising
 Inhibit the release of glucose from the liver
Advantages
 Don't cause weight gain
 Don't cause hypoglycemia (unless combined with insulin
or a sulfonylurea)
Possible side effects
 Upper respiratory tract infection
 Sore throat
 Headache
 
 Alpha-glucosidase inhibitors
Medications
 Acarbose (Glucobay 50, 100 mg )
 Miglitol ( )
Action
 Slow the breakdown of starches and some sugars
Advantages
 Don't cause weight gain
 Don't cause hypoglycemia (unless combined with insulin or a
sulfonylurea)
Possible side effects
 Stomach pain
 Gas; Diarrhea
 
 GLP-1 receptor agonists. 

Examples of GLP-1 receptor agonists: Exenatide ( ), liraglutide

(Victoza- Novo Nordisk 3ml pre filled pen s.c.) and semaglutide ( )

These injectable medications slow digestion and help lower blood

sugar levels. Their use is often associated with weight loss.
Possible side effects include nausea and an increased risk of
pancreatitis. are.
 Sodium-glucose transporter 2 (SGLT2) inhibitors

Medications

 Dapagliflozin (Forxiga-AstraZeneca. 10 mg tab)

 Empagliflozin (Jardiance (Boehringer Ingelheim), Glimpacare,
Mellitofix, Mellitofix Met).
 Canagliflozin (Invokana- Janssen Cilag=Soficopharm 100 mg tab)
Action: These drugs prevent the kidneys from reabsorbing sugar
into the blood. Instead, the sugar is excreted in the urine (Block
glucose from being reabsorbed by the kidneys)
Advantages:
Medications in this drug class may reduce the risk of heart attack
and stroke in people with a high risk of those conditions. May
promote weight loss, May lower blood pressure
Possible side effects:
 Urinary tract infections
 Yeast infections
 Rare, serious genital infection, low blood pressure, and a higher
risk of diabetic ketoacidosis.
 Table- Anti Diabetic drugs (short list)
Group Name Trade name Company Price
Biguanides Metformin Glucophage    1000 mg, 30 tab =
  Glucophage XR
Cidophage

Sulfonylureas        
Gliclazide   Diamicron Servier 60 mg 30 tab 50.25L
Glimepiride   (Amaryl) Sanofi 2 mg 30-tab 42 L
2/500 -30-tab 45 L
    Glimet Marcyrl 2.5/40; 5/800 -30 tab 22, 27 L
Glaryl Global Napi
Glyburide        
Thiazolidinediones  Pioglitazone  Actos    
Dipeptidyl-peptidase 4 (DPP-4) inhibitors     
 
  Vildagliptin Galvus Novartis 50 mg 28-tab 137 L
Galvus met
  Vildagliptin Gliptus EVA Pharma 50 mg 30 tab 104
Gliptus plus 50/1000 mg 30-tab 104L

    Icandra Mash Premier 50 mg 30-tab 69

  Sitagliptin (Januvia) Merck Sharp & 50 mg 28 t/b 220 L
Janumet Dohme 50/1000- 56 tab 220;308 L

  Linagliptin (Tradjenta) Boehringer 5mg 30 tab- 235; 329L

Ingelheim
    Glimbacare MultiCare 21-tab 160.5 L
Saxagliptin Onglyza Bristol Myers
Squibb
Sodium-glucose transporter 2 (SGLT2) inhibitors

Dapagliflozin (Forxiga) AstraZeneca 10 mg 30 tab/box 333 L

  Empagliflozin (Jardiance) Boehringer 25 mg 30 t/b 496.5 L
  Ingelheim
    Glimbacare MultiCare 21-tab 160.5 L
    Mellitofix EVA pharma 25 mg 30 t/b 297 L
    Mellitofix Met EVA pharma 12.5/1000 30 t/b 171 L