Topics

• General principles in management of diabetes

mellitus
• Drug therapy in diabetes mellitus

Presentation by
Khirod Karmoker Rupam
5th year (8th batch)
Cox’s Bazar medical College.
Aims
• Improve symptoms of hyperglycaemic
• Minimize the risks of long-term microvascular and
macrovascular complication
Treatment method:
• Dietary / lifestyle modification
• Patient Education
• Oral antidiabetic drugs
• Injected therapy
 Dietary management
Adequate glycaemic control can be obtained by diet & lifestyle advice
alone in approximately 50%

• Carbohydrate: 45-60%
• Sucrose: upto 10%
• Consumption of foods with a low glucose intake is encouraged
because they produce a slow, gradual rise in blood glucose.
Examples- starchy foods such as basmati rise, spaghetti, noodles.
• Fat: <35%
• Polyunsaturated fat: <10%
• Monosaturated fat: 10-20%
• Saturated fat: <10%
• Protein: 10-15%
• Salt- limit sodium intake to no more than 6 gm daily
• Vitamins and antioxidants- Best taken as fruits and vegetables in a
mixed diet (five portions per day)
Patient education
Patient education is the key to good glycaemic control

• Understanding of the risks of diabetes

• Potential benefits of glycaemic control
• Other measures- such as
-Maintaining a lean weight
-stopping smoking and
-taking care of feet
In patients with suspected type-1 diabetes

• Insulin is required

In patients with suspected type-2 diabetes

• First approach to advice about dietary/ lifestyle modification
• Oral antidiabetic drugs
Oral antidiabetic agent
• Metformin hydrochloride (Biguanides)
Advantage:
- It reduces the rate of gluconeogenesis
- Increase insulin sensitivity
- Does not induce hypoglycemic
- Does not predispose to weight gain

Caution:
- Adverse effect include anorexia, epigastric discomfort
- Lactic acidosis has occurred in patients with severe hepatic or renal disease & metformin is
contraindicated when this are present. ( withdraw the drug when serum creatinine >1.4
mg/dl)
• Sulfonylureas
Advantage:
- Act upon the beta cell to promote insulin secretion in response to glucose
and other secretagogues
Caution:
- Promote weight gain & are best avoided in the overweight
- They can cause hypoglycaemia
- Sulfonylureas should be used with care in patients with liver disease

Most commonly used sulfonylureas-

• Glibenclamide
• Glipizide & glimepiride
• Gliclazide
• Meglinides (insulin secretagogues)
- Repaglinide
- Nateglinide
Advantage:
• They are short acting agents that promote insulin secretion in
response to meals

Caution:
• They can cause hypoglycaemia
• Contraindicated in renal or liver disease
• Thiazolidinediones
Pioglitazone is the only remaining agent in the class

Advantage:
• Reduce insulin resistance
• Reduce hepatic glucose production

Caution:
• Weight gain
• Fluid Retention
• Heart failure
• Aggravate osteoporosis
• Alpha-glucosidase inhibitors
• Acarbose
• Miglitol
• Voglibose

Advantage:
• These reduce glucose absorption in GUT
• Reduces post prandial hypoglycaemia

Caution:
• The main side-effects GI flatulence
• Contraindicated in renal & liver disease
• Dipeptidyl peptidase-4 inhibitors
- Linagliptin
- Saxagliptin
- Sitagliptin
- Vildagliptin

Advantage:
• Most effective in the early stages of type-2 diabetes when insulin secretion is relatively
preserved
• Currently recommended for second line use in combination with metformin or a
sulfonylurea

Caution:
• The main side-effects nausia
• Occational reports of acute pancreatitis
The recommended approach for the
management of type-2 diabetes

• First line drug treatment should be metformin

• Second and third line treatment should be chosen based on
• Efficacy
• Hypoglycemic risks
• Weight effects
• Other side-effects
Thank you