Oral antidiabetic drugs
Biguanides
| e.g. metformin |
|---|
| How it works: ↓ gluconeogenesis, ↓ hepatic glucose production, ↑ peripheral glucose uptake – requires endogenous insulin (reduces basal hyperinuslinaemia) |
| Advantages: CV protection, weight loss |
| Contraindications: eGFR<35 as excreted renally |
| Adverse effects: GI upset, lactic acidosis |
Sulphonylurea
| e.g. gliclazide |
|---|
| How it works: block beta islet cell K+ channels ⇒ stimulates insulin secretion (requires residual beta cell function!) |
| Advantages: |
| Contraindications: dose change in CKD. CI in G6PD def |
| Adverse effects: hypos (esp with ↓ renal fx), weight gain, GI upset, SIADH, cholestasis |
SGLT-2 inhibitors (-gliflozin)
| Dapagliflozin, empagliflozin - risk of euglycaemic DKA hence hold when unwell |
|---|
| How it works: SGLT-2 inhibitor ⇒ ↓ renal glucose reabsorption ⇒ glycosuria |
| Advantages: CV protection, weight loss, may preserve renal fx |
| Contraindications: hepatic impairment or eGFR <60 |
| Adverse effects: UTI, ↑ infection, ↓ BP, hypos, dyslipidaemia, ⚠ euglycaemic DKA, Fournier's gangrene |
GLP-1 analogues → has its own page due to increasing popularity in recent years!
Thiazolidonediones
| e.g. glitazone |
|---|
| How it works: PPAR-gamma agonist ⇒ ↑ peripheral insulin sensitivity, ↑ muscle glucose uptake |
| Advantages: |
| Contraindications: congestive heart failure |
| Adverse effects: hypos, #, fluid retention, bladder cancer |