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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.
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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: Sulfonylureas01:17

Oral Hypoglycemic Agents: Sulfonylureas

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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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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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Dipeptidyl Peptidase 4 Inhibitors01:23

Dipeptidyl Peptidase 4 Inhibitors

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Dipeptidyl peptidase 4 (DPP-4) is a serine protease widely distributed in the body. It's involved in the inactivation of GLP-1 and GIP hormones, which are crucial for insulin regulation. DPP-4 inhibitors, such as sitagliptin (Januvia), saxagliptin (Onglyza), linagliptin (Tradjenta), alogliptin (Nesina), and vildagliptin (Galvus), help increase the proportion of active GLP-1, enhancing insulin secretion. These inhibitors work by competitively binding to DPP-4. This binding causes a...
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Insulin-replacement therapy usually includes both long-acting insulin (basal) and short-acting insulin (to cater to postprandial needs). In a diverse group of type 1 diabetes patients, the average daily insulin dose is typically 0.5-0.7 units/kg body weight. However, obese patients and pubertal adolescents may need more due to insulin resistance.
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Related Experiment Video

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Hyperinsulinemic-euglycemic Clamps in Conscious, Unrestrained Mice
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Clofibrate in insulin-dependent diabetes.

C Twomey1, A Bloom1

  • 1Departments of Medicine and Geriatrics, Whittington Hospital, N19, London.

Irish Journal of Medical Science
|August 13, 2016
PubMed
Summary

Clofibrate significantly lowered blood glucose and reduced plasma fibrinogen and pre-beta-lipoprotein in diabetic patients. Insulin needs and body weight remained unchanged, indicating good drug tolerance.

Area of Science:

  • Endocrinology
  • Metabolic Diseases
  • Pharmacology

Background:

  • Diabetes mellitus is a chronic metabolic disorder characterized by hyperglycemia.
  • Insulin therapy is a cornerstone in managing diabetes, but associated metabolic complications persist.
  • Lipid abnormalities and coagulation factors are often altered in diabetic patients.

Purpose of the Study:

  • To investigate the effects of clofibrate on glycemic control and lipid/coagulation parameters in insulin-treated diabetic patients.
  • To assess the impact of clofibrate on insulin requirements and body weight.
  • To evaluate the safety and tolerability of clofibrate in this patient population.

Main Methods:

  • A double-blind, placebo-controlled, crossover trial involving 44 diabetic patients on insulin therapy.

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  • Patients received clofibrate (2 g daily) or placebo for 6-week periods, with treatment order randomized.
  • Key outcome measures included blood glucose, insulin requirements, body weight, plasma fibrinogen, and pre-beta-lipoprotein levels.

    • Main Results:

    • Clofibrate significantly reduced mean blood glucose levels compared to placebo.
    • Significant decreases in plasma fibrinogen and pre-beta-lipoprotein concentrations were observed with clofibrate.
    • No significant changes in insulin requirements or body weight were noted.
    • Clofibrate demonstrated good drug tolerance with no adverse effects reported.

    Conclusions:

    • Clofibrate effectively improves glycemic control in insulin-treated diabetic patients.
    • Clofibrate positively impacts key markers of cardiovascular risk by reducing plasma fibrinogen and pre-beta-lipoprotein.
    • Clofibrate is a well-tolerated therapeutic option for managing metabolic parameters in diabetic individuals.