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Oral Hypoglycemic Agents: α-Glucosidase Inhibitors01:19

Oral Hypoglycemic Agents: α-Glucosidase Inhibitors

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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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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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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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Glucose Transporters01:27

Glucose Transporters

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Glucose transporters facilitate the transport of glucose across the cell membrane. In addition to glucose, some glucose transporters can also aid the movement of other hexoses such as fructose, mannose, and galactose.
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Oral Hypoglycemic Agents: Glinides01:06

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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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Sodium-Glucose Cotransporter 2 Inhibitors to Decrease the Uric Acid Concentration-A Novel Mechanism of Action.

Anna Kochanowska1, Przemysław Rusztyn1, Karolina Szczerkowska1

  • 11st Chair and Department of Cardiology, Medical University of Warsaw, 02-091 Warsaw, Poland.

Journal of Cardiovascular Development and Disease
|July 28, 2023
PubMed
Summary

Sodium-glucose cotransporter 2 inhibitors (SGLT2is) significantly lower serum uric acid (SUA) levels. This effect, potentially linked to increased urinary uric acid excretion, may explain some of their cardiovascular benefits.

Keywords:
SGLT2iflozinsgoutsodium–glucose cotransporter 2 inhibitorsuric acid

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Area of Science:

  • Cardiology
  • Nephrology
  • Endocrinology

Background:

  • Sodium-glucose cotransporter 2 inhibitors (SGLT2is) are established glucose-lowering agents with significant cardiovascular benefits.
  • These benefits extend to improved lipid profiles, blood pressure, atherosclerosis risk, and reduced cardiovascular events and mortality.
  • A potential mechanism for these pleiotropic effects involves the impact of SGLT2is on serum uric acid (SUA) concentration.

Purpose of the Study:

  • To synthesize findings from meta-analyses regarding the effect of SGLT2is on SUA levels.
  • To explore factors influencing the SGLT2i-mediated reduction in SUA.
  • To discuss the potential implications of SUA modulation by SGLT2is in cardiovascular disease and gout treatment.

Main Methods:

  • Systematic review and meta-analysis of existing studies.
  • Analysis of drug- and dose-dependency of SGLT2i effects on SUA.
  • Investigation of influencing factors such as HbA1c, diabetes status, and baseline SUA.

Main Results:

  • Nine meta-analyses confirmed that SGLT2is significantly reduce SUA levels.
  • Data regarding drug- and dose-dependency were inconclusive.
  • Factors like HbA1c, diabetes presence, and baseline SUA influence the SUA-lowering effect.

Conclusions:

  • SGLT2is demonstrably lower SUA, likely through increased urinary uric acid excretion.
  • The precise mechanism requires further elucidation.
  • Modulation of SUA by SGLT2is may contribute to their cardiovascular protective effects and has potential therapeutic applications in gout.