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Oral Hypoglycemic Agents: Glinides01:06

Oral Hypoglycemic Agents: Glinides

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Repaglinide (Prandin) and Nateglinide (Starlix), known as glinides, are oral insulin secretagogues that stimulate insulin release from pancreatic β cells by closing the ATP-sensitive potassium channels (KATP channel). Repaglinide controls insulin release from pancreatic β cells by managing potassium efflux. It shares two binding sites with sulfonylureas and also has a unique site, indicating overlapping mechanisms of action. With a rapid onset and a 4-7 hour duration, it effectively...
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Oral Hypoglycemic Agents: α-Glucosidase Inhibitors01:19

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α-glucosidase inhibitors, including acarbose (Precose), miglitol (Glyset), and voglibose (Voglib) (primarily available in Asia), are drugs that control blood sugar levels by delaying the digestion of starch and disaccharides. They achieve this by inhibiting α-glucosidase enzymes in the intestine, which slow the absorption of carbohydrates in the intestine, which in turn leads to a prolonged release of the glucoregulatory hormone GLP-1 from intestinal L-cells.
Acarbose and miglitol are...
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Oral Hypoglycemic Agents: Biguanides and Glitazones01:26

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Biguanides, particularly metformin (Glucophage), are insulin sensitizers that enhance glucose uptake, thereby reducing insulin resistance. Unlike sulfonylureas, metformin doesn't prompt insulin secretion, which helps to curb hypoglycemia risk. Metformin is beneficial in treating conditions like polycystic ovary syndrome due to its insulin-resistance reduction capability. The drug's primary action involves curtailing hepatic gluconeogenesis, a significant contributor to high blood...
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Hypoglycemia and Glucagon01:15

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Without prolonged fasting, healthy individuals maintain blood glucose levels above 3.5 mM due to a well-adapted neuroendocrine counterregulatory system that effectively prevents acute hypoglycemia, a potentially life-threatening condition. The primary clinical scenarios for hypoglycemia encompass diabetes treatment, inappropriate production of endogenous insulin or insulin-like substances by tumors, and the use of glucose-lowering agents in non-diabetic individuals. Notably, hypoglycemia in the...
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Oral Hypoglycemic Agents: Sulfonylureas01:17

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Sulfonylureas are oral hypoglycemic agents utilized in treating type 2 diabetes. They are characterized by their unique sulfonylurea chemical structure. The family of sulfonylureas is divided into generations. First-generation sulfonylureas, including tolbutamide (Orinase), chlorpropamide (Diabinese), and tolazamide (Tolinase), trigger insulin release from pancreatic β cells and enhance peripheral tissues' insulin sensitivity. The second-generation members, such as glipizide...
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Glucagon-like Receptor Agonists01:24

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Incretins include glucagon-like peptide-1 (GLP-1) and glucose-dependent insulinotropic polypeptide (GIP), which stimulate insulin secretion post-meals. In type 2 diabetes, GIP's efficacy is reduced, making GLP-1 a viable drug target. GIP originates from preproGIP.
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Improving IV Insulin Administration in a Community Hospital
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Oral hypoglycemic agents: do the ends justify the means?

Oded Langer1

  • 1Columbia University, New York, USA.

Maternal Health, Neonatology and Perinatology
|April 9, 2016
PubMed
Summary

This review examines the efficacy of oral hypoglycemic agents versus insulin for gestational diabetes mellitus (GDM). It highlights methodological issues in studies and emphasizes achieving glycemic control to reduce maternal and fetal complications.

Keywords:
Gestational diabetesGlyburideHealth research designMetformin

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Area of Science:

  • Obstetrics and Gynecology
  • Endocrinology
  • Pharmacology

Background:

  • Glyburide is now a first-line treatment for gestational diabetes mellitus (GDM) in the US, often favored over insulin due to cost and patient convenience.
  • Recent studies question the efficacy of oral hypoglycemic agents (OHAs) like glyburide and metformin for GDM management.
  • Key concerns include placental drug transfer, evidence quality, and comparative effectiveness for primary and secondary outcomes.

Purpose of the Study:

  • To address concerns regarding the efficacy and safety of oral hypoglycemic agents in treating gestational diabetes mellitus.
  • To critically evaluate the quality of evidence and data sources used in GDM treatment studies.
  • To compare the effectiveness of different treatment modalities in managing GDM and its outcomes.

Main Methods:

  • Qualitative summary and assessment of theoretical and empirical evidence from existing literature.
  • Analysis of methodological issues in study designs impacting GDM intervention results.
  • Review of various study designs and their potential to yield varying results for the same research question.

Main Results:

  • Methodological limitations in study designs can significantly impact the reported results of GDM healthcare interventions.
  • Different study designs can produce conflicting outcomes when addressing the same clinical question.
  • The importance of achieving targeted glycemic control levels in GDM management is underscored.

Conclusions:

  • Critical gaps exist in the literature regarding the efficacy of OHAs for GDM.
  • Emphasis on patient-centered treatment is crucial for managing hyperglycemia and reducing fetal and maternal morbidity.
  • Defining appropriate outcome criteria and utilizing effective pharmacological therapies are essential for GDM management.