NEW IN THE TREATMENT OF TYPE 2 DIABETES
DOI:
https://doi.org/10.14739/2310-1210.2014.1.23806Keywords:
diabetes mellitus type 2, hypoglycemic drugs, the results of the researchAbstract
Diabetes mellitus (DM) is a major medical and social problem almost in all countries of the world. Currently, there are more and more various pharmacological agents that make management of the glycaemia in patients with type 2 diabetes extremely difficult. Therefore, when the physician is faced with the choice of glucose-lowering therapy, he should be clearly aware of all the options in contemporary treatment. 11 groups of hypoglycemic agents are used for the treatment of type 2 diabetes
The biguanides. According to modern concepts, biguanides inhibit the oxidation of glucose by stimulating anaerobic glycolysis. Both in the consensus of ADA / EASD, and in the IDF recommendations metformin may be the drug of the choice for hypoglycemic therapy of diabetes type 2.
Sulfonylurea derivatives: glibenclamide, glimepiride, gliquidone, Glipizide. They belong to a group of secretagogues, as their action is based on the ability to stimulate the secretion of insulin by ß-cells of the pancreas.
Prandial glucose regulators. Meglitinides (repaglinide and nateglinide) stimulate insulin secretion by ß-cells. Due to the rapid normalization of stimulated insulin level after taking the drugs the risk of hypoglycaemia between meals is minimized.
Insulin sensitayzers. Thiazolidinediones (rosiglitazone, pioglitazone) reduce insulin resistance of peripheral tissues by binding to receptors, activating peroxisome proliferation (PPARg) in the nuclear membrane.
Alpha-glucosidase inhibitors (acarbose, miglitol, voglibose) competitively inhibits intestinal enzymes (α-glucosidase). It consequently slows carbohydrate absorption from foods and supply of glucose into the blood.
Incretin mimetics. Analogues of glucagon-like peptide 1 (GLP-1) stimulate the biosynthesis and secretion of insulin, regulate food consumption, support ß-cells in a healthy state, suppress glucagon secretion, depending on the glucose levels, affect the rate of gastric emptying, stimulat proliferation of ß-cells. They include the following drugs: exenatide, exenatide-LAR, liraglutide, liksizenatid, albiglyutid, dulaglyutid. GLP-1 is splited by dipeptidyl peptidase type 4 (DPP-4), which formed the basis for the creation of inhibitors of the enzyme DPP-4 and thus the maintaince of GLP-1 effect. There are the following inhibitors of DPP-4: sitagliptin, saxagliptin, vildagliptin, linagliptin, alogliptin.
Inhibitors of sodium-glucose cotransporter 2 (SGLT2). Their mechanism of action is reduced to the suppression of glucose reabsorption in the kidney, followed by reduction of hyperglycemia. Representatives of the group are dapagliflozin and kanagliflozin.
The other three groups of drugs: amylin mimetics (pramlintide), bile acid sequestrants (cholestyramine and colestipol) and dopamine-2 agonists (bromocriptine) are used only in addition to the treatment of diabetes. Conclusions. The choice of drug therapy is a difficult and complex task. The heterogeneity of patients with type 2 diabetes suggests, that for effective treatment of this chronic progressive disease may not be an optimal use of only one class of glucose-lowering drugs. When physicians select treatment strategy against type 2 diabetes, he should rely on the national and international clinical guidelines and research results, as well as on his own clinical experience, and be sure to take into account the individual characteristics of the patient.
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