Question

A 45-year-old gentleman comes to see you for advice on starting medications for his high sugars:
How do you classify oral anti-diabetic drugs? Write briefly about them.

Hint:

Metformin is usually the first-line oral drug due to its safety profile and effectiveness in lowering blood glucose.

Answer 1

Step 1: Understanding the classification.
Oral anti-diabetic drugs are used to manage blood glucose levels in Type 2 diabetes. They act through different mechanisms such as improving insulin sensitivity, increasing insulin secretion, or reducing glucose absorption.

Step 2: Explanation of the classes.
- Insulin Secretagogues (Sulfonylureas and Meglitinides): These drugs increase insulin secretion from the pancreas. Examples include Glibenclamide (sulfonylurea) and Repaglinide (meglitinide).
- Biguanides (Metformin): Metformin reduces hepatic glucose production and improves insulin sensitivity. It is often the first-line treatment.
- Alpha-glucosidase Inhibitors: These drugs delay carbohydrate digestion and absorption in the small intestine, preventing post-meal blood sugar spikes.
- Thiazolidinediones (TZDs): These drugs improve insulin sensitivity in muscle and adipose tissue by acting on peroxisome proliferator-activated receptor gamma (PPAR-γ). Examples include Pioglitazone.
- Dipeptidyl Peptidase-4 (DPP-4) Inhibitors: These drugs prolong the action of incretin hormones, which enhance insulin secretion and inhibit glucagon release.
- Sodium-Glucose Co-Transporter-2 (SGLT2) Inhibitors: These drugs prevent glucose reabsorption in the kidneys, leading to increased urinary glucose excretion.
- Glucagon-Like Peptide-1 (GLP-1) Agonists: These medications mimic the action of GLP-1, which enhances insulin secretion and suppresses glucagon release.

Step 3: Conclusion.
Oral anti-diabetic drugs play a vital role in the management of Type 2 diabetes by targeting different mechanisms to control blood sugar levels.