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[Current and future aspects of oral antidiabetic agents in type 2 diabetes]
1Interní klinika IPVZ, Bat'ova nemocnice, Zlín.
Abstract:
Type 2 diabetes mellitus is characterized by insulin deficiency but in particular by insulin resistance. Patients where it is not possible to achieve positive results within 4-12 weeks by optimalization of the lifestyle are candidates for treatment with oral antidiabetics. At present the following main groups of oral antidiabetics are discussed: insulin secretagogues (SU derivatives and methiglinide derivatives), biguanides (Metformin), alpha-glucosidase inhibitors (acarbose, miglitol) and insulin sensitizers (thiazolindiones). Traditional SU therapy improves the insulin plasma levels by releasing insulin from the pancreas. This implies further stress on the b-cells and the function of these cells declines reversibly. Biguanides, such as metformin, are effective substances reducing the blood sugar level, they are however associated with the problem of tolerability and are contraindicated in some diabetics. A new approach to the treatment of type 2 diabetes are thiasolinediones, insulin-sensitizing substances, the molecular basis of their action being via activation of PPAR gamma-nuclear receptors with subsequent change in expression of genes participating in carbohydrate and lipid metabolism.
Insights
Type 2 diabetes treatment involves oral antidiabetics like metformin and thiazolidinediones. Thiazolidinediones offer a new approach by activating PPAR gamma receptors to improve insulin sensitivity.
Area of Science:
- Endocrinology
- Metabolic Diseases
- Pharmacology
Background:
- Type 2 diabetes mellitus (T2DM) is defined by insulin resistance and deficiency.
- Lifestyle modifications are primary T2DM treatments, but oral antidiabetics are needed when these fail.
- Current oral antidiabetic classes include insulin secretagogues, biguanides, alpha-glucosidase inhibitors, and insulin sensitizers.
Purpose of the Study:
- To review the main classes of oral antidiabetics for T2DM.
- To discuss the mechanisms of action and limitations of existing therapies.
- To introduce thiazolidinediones as a novel therapeutic approach.
Main Methods:
- Review of existing literature on oral antidiabetic agents.
- Comparison of mechanisms of action for different drug classes.
- Discussion of clinical considerations and limitations.
Main Results:
- Sulfonylurea (SU) derivatives stimulate insulin secretion, potentially stressing beta-cells.
- Biguanides, like metformin, effectively lower blood glucose but have tolerability issues and contraindications.
- Thiazolidinediones represent a new class that enhances insulin sensitivity via PPAR gamma activation.
Conclusions:
- Oral antidiabetics are crucial for managing T2DM when lifestyle changes are insufficient.
- Different drug classes offer varied mechanisms, each with specific benefits and drawbacks.
- Thiazolidinediones offer a promising insulin-sensitizing strategy through nuclear receptor modulation.