Anti-diabetic drug

Anti-diabetic drug
A diabetes medicine is a medicine used to treat diabetes mellitus. Antidiabetic generally act by lowering blood glucose. There are different types of antidiabetic agents, and their use depends on the nature of diabetes, age and situation of the person, and many other factors.

Thus, in type 1 diabetes, there is no physiological insulin secretion. Insulin administration is the mainstay of treatment and the use of oral antidiabetics is not indicated. In contrast, in type 2 diabetes, insulin secretion is present but insufficient to obtain a physiological effect. Treatment therefore consists of the administration of oral antidiabetic which will increase the secretion or promote tissue sensitivity to insulin.

Oral antidiabetic
Oral hypoglycemic agents (OHA) are used in diabetes type 2 (non-insulin-dependent), where they can be sometimes (not always) prescribed in combination with insulin. There are four classes of drugs that have proven effective for treating type 2 diabetes.

* The sulfonylureas.
* Biguanides.
* The glitazones.
* Inhibitors of alpha-glucosidase.

Other oral agents have not demonstrated efficacy in preventing clinical complications of diabetes. However, the standards of HAS (Haute Autorité de Santé) changes each year, as many studies are underway.

The Biguanides decrease hepatic gluconeogenesis and insulin resistance of the body:

* Metformin, a drug of first choice in the treatment of diabetes non-insulin-dependent

Main article: Metformin.

* Phenformin (not used)
* Buformine (Switzerland)

The Glitazones (Thiazolidinediones) decreased tissue resistance to insulin. They are used as third line in the treatment of type 2 diabetes.

* Pioglitazone (Actos ®)
* Rosiglitazone (Avandia ®)
* Troglitazone (not used out)

Side Effects
* Weight
* Edema from sodium and water retention.
* Visual disturbances.
* Respiratory Infections (Colds, sinusitis ...)
* Insomnia.

In combination with metformin:
* Edema.
* Anemia.
* Headaches.
* Joint pain.
* Blood in the urine.
* Erectile dysfunction.
* Flatulence.

In combination with a sulphonylurea:
* Edema
* Dizziness
* Flatulence,
* Hypoglycemia
* Presence of sugar or protein in urine,
* Increased appetite
* Headaches
* Dizziness
* Fatigue
* Excessive sweating.

Cons indications
* Hepatic.
* Congestive heart.
* Severe renal impairment.
* Recent myocardial infarction.
* Pregnancy.
* Breastfeeding.

Their use with insulin may increase the risk of heart failure. Studies are underway to better evaluate the benefit / risk.

Drug Interaction
This medication may be prescribed with a biguanide, however, this association has not proven its clinical effectiveness.

The combination of these molecules with corticosteroids, antiasmathiques bronchodilators, diuretics or angiotensin converting enzyme may require more frequent monitoring of blood glucose, or a change of dosage of oral antidiabetic.

Inhibitors of alpha-glucosidase
Inhibitors of alpha-glucosidase inhibitors inhibit the last stage of digestion of sugars. Those methods can not be absorbed in the gut and still undergoing colonic bacterial fermentation volatile fatty acids or is excreted in the feces. This class of antidiabetic agent is used in addition to the other or at cons-indication to other treatments.

* Acarbose
* Miglitol

Side Effects
* Digestive problems (flatulence, flatulence, intestinal discomfort, diarrhea, bloating ...)
* Rash.

These effects tend to diminish during treatment.

* Disorder of digestion and absorption.
* Inflammatory bowel.
* Intestinal hernia.
* Antecedent subocclusif syndrome.
* Severe renal impairment.
* Children under 15 years for acarbose and 18 for miglitol.
* Breastfeeding.
* Pregnancy.

See also Rosiglitazone