Drugs used to treat Diabetes!

Drugs used to treat Diabetes

There are more than 34 million patients with diabetes throughout the United States, and almost half a billion cases globally.

Diabetes is set to rocket further in the years and decades ahead. Almost 1 in 5 Americans are expected to be diabetic by 2060, if the current trend continues.

Diabetes type 2 is a condition that, in the long term, can affect multiple organ systems. For example, diabetes can lead to:

• Vision loss / blindness
• Increased risk of heart attacks and strokes
• Kidney damage / kidney failure
• Nerve damage, potentially leading to limb amputation

Though lifestyle changes, such as weight loss and regular exercise and an improved diet, are highly beneficial in patients with type 2 diabetes, many patients also require drugs and medicines to help manage this chronic condition.

For the purposes of the PTCB exam, pharmacy technicians are expected to know the major drug classes used to manage the condition. Whilst technicians are not expected to know each class in detail, you should know the broad outline:

• Recognizing the major drug classes
• Basic details on how the drug works
• Any significant side effects associated with each drug class
• Any significant drug interactions associated with each drug class

Below, we briefly summarize all major antidiabetic drug classes you need to know.

Antidiabetic Drug Classes

There are six major antidiabetic drug classes technicians need to know for the PTCB exam:

• insulins
• sensitizers
• alpha-glucosidase inhibitors
• peptide analogs
• glycosurics
• secretagogues

Insulins

Insulin is used to help replace insulin in patients with type 1 diabetes and to control blood glucose levels in patients with type 2 diabetes.

There are four major insulin classes:

Insulin Class	Examples
Rapid acting	Regular insulin Lispro Aspart Glulisine
Intermediate-acting	Isophane insulin Insulin zinc
Long-acting	Insulin glargine Insulin detemir
Ultra long-acting insulin	Degludec Glargine U300

Sensitizers

As the name suggests, sensitizers are drugs that increase the body’s sensitivity to insulin – making it more effective at controlling blood sugar levels in affected patients.

There are two major sensitizer classes:

• Biguanides – which includes the drug metformin
• Thiazolidinediones – which includes drugs such as pioglitazone

Metformin is the most prescribed drug for patients with type 2 diabetes. Unlike many other antidiabetic drugs, it does not cause weight gain. This makes the drug particularly effective for patients whose type 2 diabetes is linked to obesity. In some patients, metformin can even induce weight loss. We talked about metformin in more detail in an earlier PTCB blog.

Glitazones – such as pioglitazone and rosiglitazone – work by activating PPAR-gamma. However, their use is associated with an increased risk of cardiovascular events, such as heart attack and stroke.

Alpha-Glucosidase Inhibitors

Alpha-glucosidase are less likely to be used to manage type 2 diabetes, but they can be used when first-line drugs have proven insufficient.

Examples of alpha-glucosidase inhibitors include:

• Acarbose
• Miglitol

Type 2 diabetes invariably centers around blood sugar levels. Carbohydrates are nutrients which when digested, metabolize into sugars. Alpha-glucosidase inhibitors are drugs that slow carbohydrate metabolism, thereby slowing the rate of sugar absorption into the body. This reduces the risk of elevated high blood sugar (hyperglycemia).

Side effects are gastrointestinal related and include bloating, flatulence, and diarrhea.

Peptide Analogs

Peptides are short chains of amino acids linked by chemical bonds called peptide bonds.

Analogs of peptides are effective in the treatment of type 2 diabetes. These include drugs such as:

• GLP-1 agonists – liraglutide, exenatide
• DPP-4 inhibitors – saxagliptin, linagliptin, sitagliptin

Both GLP-1 agonists and DPP-4 inhibitors promote the release of insulin from the pancreas; the pancreas being the organ responsible for the synthesis and release of the insulin hormone.

You may be asked PTCB test questions on either of these drug classes so it’s important to keep these drugs in mind during your study. Remember, technicians are expected to know all major drugs used to treat diabetes.

Glycosurics

Let’s break down the name here – glycos, referring to sugar, and –uric, referring to elimination, such as through the urine.

That’s exactly how glycosuric drugs work – they promote the elimination of sugar through urine from the body. This helps to lower blood sugar levels in patients with type 2 diabetes.

The major glycosuric drug class are SGLT-2 inhibitors.

Examples include:

• Dapagliflozin
• Empagliflozin
• Canagliflozin

You can already identify that SGLT-2 inhibitors all end with the suffix –flozin.

Possible adverse effects of SGLT-2 inhibitors include an increased risk of urinary tract infections, elevated cholesterol, thirst, hypoglycemia, and an increased risk of diabetic ketoacidosis.

Secretagogues

As the name suggests, secretagogues help the body secrete – or release – insulin from the pancreas.

Examples of secretagogue drug classes include:

• Sulfonylureas – glipizide, glyburide, gliclazide
• Meglitinides – rapeglinide, nateglinide

Both sulfonylureas and meglitinides act at the same target in the pancreas – namely, pancreatic beta cells (just they act at different sites on these cells).

One of the drawbacks of both sulfonylureas and meglitinides is that they can cause weight gain, which may prove problematic in patients whose type 2 diabetes was caused by obesity.

In Review

We have now reviewed all major drugs used to treat diabetes.

Remember though, that this is only intended to act as a brief overview. If you can commit these facts to memory, it acts as a great base upon which you can add further details and knowledge of these antidiabetic drug classes.

Here is a final review of the drug classes we have studied:

Antidiabetic Drug Class	Examples
Insulins Fast acting Intermediate acting Slow acting Ultra long acting	lispro, aspart, glulisine isophane insulin; insulin zinc glulisine degludec; glulisine U300
Sensitizers Biguanides Thiazolidinediones	metformin pioglitazone
Alpha-glucosidase inhibitors	acarbose              miglitol
Peptide Analogs GLP-1 agonists DPP-4 inhibitors	liraglutide; exenatide saxagliptin; linagliptin; sitagliptin
Glycosurics SGLT-2 inhibitors	empagliflozin; dapagliflozin
Secretagogues Sulfonylureas Meglitinides	glipizide; glyburide; gliclazide rapeglinide; nateglinide

If you can even commit this table of details and some major side effects and drug interactions to memory, you will be well prepared to answer PTCB exam questions on this topic. Though as we cautioned earlier, you should ideally read more beyond this foundational base of knowledge.

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