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Oral antidiabetic drugs: an overview
1Department of Clinical Pharmacology, Lund University, Medical Research Centre, Malmö General Hospital, Sweden.
Diabetic Medicine : a Journal of the British Diabetic Association
|September 1, 1996
Summary
Chronic hyperglycaemia increases macrovascular disease risk. Effective management requires addressing insulin resistance and secretion issues, often necessitating oral antidiabetic drugs alongside lifestyle changes for optimal glucose control.
Area of Science:
- Endocrinology
- Metabolic Diseases
- Pharmacology
Background:
- Chronic hyperglycaemia, including impaired glucose tolerance (IGT) and NIDDM, significantly elevates macrovascular disease risk.
- Both insulin resistance and impaired insulin secretion are critical in developing and exacerbating chronic hyperglycaemia.
Purpose of the Study:
- To outline strategies for preventing and treating chronic hyperglycaemia, aiming for normoglycaemia.
- To evaluate the role and timing of oral antidiabetic drugs in managing hyperglycaemia.
Main Methods:
- Review of non-pharmacologic treatments and their limitations in achieving normoglycaemia.
- Assessment of various oral antidiabetic drug classes, including sulphonylureas, non-sulphonylureas, and metformin, for their efficacy and safety profiles.
- Discussion of combination therapy for advanced NIDDM.
Main Results:
- Non-pharmacologic measures alone are rarely sufficient for achieving normoglycaemia.
- Rapid-acting insulin secretagogues are justified due to delayed early insulin response in hyperglycaemia.
- Metformin improves insulin action without causing hyperinsulinaemia or hypoglycaemia, and combination therapy with sulphonylureas is effective in advanced NIDDM.
Conclusions:
- Therapeutic goals for chronic hyperglycaemia should focus on normoglycaemia, integrating pharmacologic and non-pharmacologic approaches.
- Early intervention with oral antidiabetic drugs, after optimizing lifestyle measures, enhances euglycaemic control.
- Metformin and combination therapies offer effective management strategies for NIDDM, with careful consideration of patient factors like renal function.