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Related Concept Videos

Diabetes: Management and Pharmacotherapy01:15

Diabetes: Management and Pharmacotherapy

763
The therapy for diabetes aims to alleviate hyperglycemia-related symptoms, prevent acute metabolic decompensation, and reduce chronic end-organ complications. Glycemic control is evaluated through short-term (self-monitoring, continuous glucose monitoring) and long-term (A1c, fructosamine) metrics, enabling near real-time tracking of blood glucose levels and reflecting glycemic control over specific time frames.
Insulin remains the cornerstone of treatment for most patients with type 1 and many...
763
Oral Hypoglycemic Agents: Biguanides and Glitazones01:26

Oral Hypoglycemic Agents: Biguanides and Glitazones

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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...
503
Oral Hypoglycemic Agents: α-Glucosidase Inhibitors01:19

Oral Hypoglycemic Agents: α-Glucosidase Inhibitors

436
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...
436
Oral Hypoglycemic Agents: Glinides01:06

Oral Hypoglycemic Agents: Glinides

468
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...
468
Dipeptidyl Peptidase 4 Inhibitors01:23

Dipeptidyl Peptidase 4 Inhibitors

433
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...
433
Glucagon-like Receptor Agonists01:24

Glucagon-like Receptor Agonists

674
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.
GLP-1, when administered in high doses intravenously, triggers insulin secretion, inhibits glucagon release, slows gastric emptying, reduces food intake, and restores normal insulin secretion. However, its rapid inactivation by...
674

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Pharmacotherapeutic options for prediabetes.

Marc Rendell1,2

  • 1The Rose Salter Medical Research Foundation , Newport Coast, CA, USA.

Expert Opinion on Pharmacotherapy
|September 7, 2020
PubMed
Summary

Prediabetes management may require more than lifestyle changes. Newer medications like GLP-1 receptor agonists and SGLT2 inhibitors show promise in preventing diabetes progression, especially for overweight individuals.

Keywords:
Prediabetesdiabetes preventionimpaired fasting glucoseimpaired glucose toleranceobesityweight loss

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Area of Science:

  • Endocrinology
  • Metabolic Disorders
  • Pharmacology

Background:

  • Prediabetes signifies elevated blood glucose levels below the diabetes diagnostic threshold.
  • The landmark Diabetes Prevention Program (DPP) study highlighted lifestyle interventions over metformin for diabetes prevention.
  • Long-term implications of the DPP's findings on prediabetes treatment require further examination.

Purpose of the Study:

  • To review pharmacologic strategies for preventing diabetes in individuals with prediabetes.
  • To assess the efficacy of various drug classes in managing prediabetes.
  • To provide an expert opinion on optimal prediabetes treatment approaches.

Main Methods:

  • Literature review of pharmacologic treatments for prediabetes.
  • Utilized PubMed.gov with keywords: prediabetes, impaired fasting glucose, impaired glucose tolerance.
  • Focused on studies examining diabetes prevention in prediabetic populations.

Main Results:

  • Lifestyle interventions in the DPP study reduced diabetes risk by 58%, while metformin achieved a 31% reduction.
  • Subsequent pharmacologic efforts are reviewed to assess their role in diabetes prevention.
  • Prediabetes is strongly linked to being overweight, with obesity posing additional health risks.

Conclusions:

  • Weight loss is a primary goal in prediabetes management.
  • Pharmacologic agents, including GLP-1 receptor agonists and SGLT2 inhibitors, are recommended for weight management and diabetes prevention.
  • A comprehensive approach integrating pharmacotherapy with lifestyle modifications is crucial for effective prediabetes treatment.