About 177 million people have diabetes worldwide (WHO 1999) and the number is projected to rise to 300 million people by the year 2025.
Diabetes mellitus type 2 accounts for about 80% of diabetes mellitus cases worldwide.
For proper, management and control of diabetes mellitus type 2, most cases will require the use of antidiabetic drugs in addition to dietary modification and increased physical exercise. There are presently 5 different types of drugs available for control of diabetes:
A) Sulfonylureas
B) Biguanides
C) Meglitinides
D) Thiazolinediones
E) Alpha-glucosidase inhibitors
We are going to be looking at the last 3 group of drugs.
Meglitinides
These are a novel class of non sulfonylureas insulin secretogogues (drugs that stimulate the pancreas to secrete more insulin).
-They have quick onset of action and short duration of action (they act very quickly and fast).
-They stimulate insulin release in a glucose sensitive manner, and unlike the sulfonyureas they don't secrete insulin in the absence of glucose.
-They enhance glucose stimulated insulin secretions especially when glucose levels get to 180mg/dl.
-Side effects include hypoglycemia (low glucose levels due to over reduction), headache, rhinitis, bronchitis.
-Examples include repaglinide and nateglinide.
Thiazolinediones
This group of drugs were originally discovered and characterized for their glucose and lipid lowering activity.
-They act by decreasing insulin resistance and enhancing biological response to insulin by the body cells. The increased insulin sensitivity results in reduction of blood glucose and free fatty acids (body fat).
-They exhibit a characteristic delay from 4-12 weeks in the onset of their actions after intake.
-Their major side effects include weight gain, decreased hemoglobin levels, and elevated but reversible liver enzymes concentrations.
-Examples include Pioglitazone and Rostiglitazone.
Alpa-glucosidase inhibitors
-These group of antidiabetic drugs function by blocking the enzymatic degradation of complex carbohydrates in the small intestine thus reducing glucose absorption.
-They lower post prandial[post eating)glucose level in the blood and improve blood glucose control without the risk of weight gain or hypoglycemia.
-They are competitive reversible inhibitors of pancreatic alpha amylase and membrane bound