What Are Oral Hypoglycemic Agents?

With the improvement of people's living standards, the incidence of diabetes has increased dramatically. World Health Organization experts predict that humans will face the disaster of diabetes in the 21st century. The cost of treatment for diabetes and its complications will far exceed that for AIDS. cost of. Most of the diabetic patients are type 2 diabetic patients, and oral hypoglycemic drugs play an extremely important role in the treatment of these patients.

Drug Name: Oral hypoglycemic agent

Dosage form: Oral preparation
Drug type: chemical

Indications for oral hypoglycemic agents

Oral hypoglycemic drugs are mainly used to treat patients with type 2 diabetes whose blood sugar cannot be satisfactorily controlled after 2 to 3 months of diet and exercise. Type 1 diabetes can only be used in combination with sulfonylurea, except for sulfonylurea, as appropriate Blood sugar medicine.

Effect of oral hypoglycemic drugs

1. Stimulate pancreatic secretion of pancreas.

2. Increasing the application of cells to pancreatic conductin.

3 Inhibits insulin production in the liver.

4 Increases glucose oxidation in surrounding tissues.

The development of oral hypoglycemic diabetes

The food we consume every day is converted into glucose through the stomach and the small intestine. Glucose enters cells through the appearance of insulin. Finally, the cells use glucose to convert into "fuel" to provide the body with the energy needed to maintain daily life. Problems with any of these steps can cause diabetes. ^[1]

Classification of oral hypoglycemic agents

At present, oral hypoglycemic agents that are commonly used in clinical practice are generally divided into four categories according to their mechanisms of lowering blood glucose: sulfonylureas (SU), biguanides, alpha glucosidase inhibitors and insulin potentiators. In order to avoid the blindness of medication, it is necessary to understand the hypoglycemic mechanism of different varieties of oral hypoglycemic drugs, the concentration and time of action, the degradation and elimination pathways and adverse reactions, etc., and then combine the specific conditions of the patient, including the severity, obesity, presence Insulin resistance or hyperinsulinemia, age, liver and kidney function and other conditions, targeted choice of medication. The characteristics of the commonly used preparations of these 4 types of drugs are briefly introduced below.

Oral hypoglycemic drugs

Sulfonylurea oral hypoglycemic agents are widely used in clinical practice. At present, the first-generation SU oral hypoglycemic agents commonly used in clinical practice are D-860 and chlorosulfuramide, and the second-generation SU oral hypoglycemic agents are superior hypoglycemic, mepyridine, and damecan (glitazide). , Grams of sugar and sugar moderate. The main difference between the first generation of SU oral hypoglycemic drugs and the second generation of SU oral hypoglycemic drugs is the difference in the strength and dosage of the hypoglycemic effect. generation. The main mechanism of the hypoglycemic effect of SU oral hypoglycemic drugs is to stimulate insulin secretion, rather than increase insulin synthesis. Therefore, SU oral hypoglycemic drugs are most suitable for patients with mild to moderate type 2 diabetes, especially with insulin secretion. Incompetent.

Oral antidiabetic drugs

Commonly used formulations are hypoglycemic and hypoglycemic tablets (metformin). The mechanism of oral hypoglycemic action of biguanides is different from that of SU. The main mechanism is to increase the anaerobic fermentation of sugar; improve the resistance of surrounding tissues to insulin; and inhibit the absorption of sugar in the intestinal tract and the production of liver sugar. It is the first choice for patients with type 2 diabetes, especially for obese patients with insulin resistance or insulinemia. Biguanides can also be used in combination with insulin to treat patients with type 1 diabetes, which can reduce the amount of insulin and stabilize fluctuating blood sugar.

Glucosidase inhibitor

Commonly used formulations are acarbose (baitangpin) and miglitol. The mechanism of hypoglycemic action of these drugs is mainly through inhibiting the conversion of polysaccharides and disaccharides to monosaccharides, thereby reducing and delaying the absorption of sugars and lowering blood sugar after meals. Its hypoglycemic effect is relatively weak, so it should be combined with other hypoglycemic drugs, or used alone in mild patients with postprandial hyperglycemia as the main manifestation. The main toxic and side effects are upper abdominal pain, flatulence, diarrhea or constipation, so people with gastrointestinal diseases should not take it. Baitangping is insoluble and has more toxic and side effects than miglitol. The latter is soluble and has less toxic and side effects, which is more suitable for elderly patients with diabetes.

Oral hypoglycemic agent insulin booster

These drugs are thiazolidone compounds.The mechanism of hypoglycemia is mainly to increase the uptake and utilization of sugar in surrounding tissues and reduce the production of liver sugar. Therefore, it is particularly suitable for patients with type 2 diabetes who are mainly insulin resistance. .

Choice of oral hypoglycemic agents

1. To avoid abuse, do not blindly take medicine for people with unknown diagnosis, use it if you do nt use it, do nt use it if you can use it, use less if you can use it. The daily dosage of any one oral hypoglycemic agent should not exceed 6 tablets, otherwise the hypoglycemic effect cannot be increased much, and the adverse reactions are significantly increased. In clinical practice, some people often use powerful hypoglycemic drugs such as urethane, or use urethane together with urinary hypoglycemic pills. This is wrong and dangerous. It is particularly at risk of causing hypoglycemia.

2 There are many types of oral hypoglycemic agents that vary from time to time, with different characteristics. Before use, you should carefully understand the patient's medical history and current situation, and choose the most appropriate oral hypoglycemic agent and the most appropriate dose according to the specific circumstances of the patient. Patients with insulin-dependent diabetes mellitus generally do not use sulfonylureas; patients with heavier heart, lung, kidney or hypoxic diseases and elderly patients should not use or use biguanides and powerful sulfonylureas to prevent lactic acid The occurrence of acidosis or hypoglycemia; those with a tendency to ketosis or hypoxia should not use a large amount of biguanide drugs such as hypoglycemic; patients with light weight or normal weight can first choose sulfonylurea oral hypoglycemic drugs according to the situation, For obese patients, the impact of diet and exercise on blood glucose control should be analyzed first, diet adjustments should be made, and biguanide oral hypoglycemic drugs should be selected first; for pregnant women, insulin treatment should be used.

3. Choice of oral hypoglycemic drugs for elderly diabetic patients. Generally, elderly patients with diabetic diseases are relatively mild, and mild hypoglycemic drugs such as D-860 or Damcon are recommended. Even if the condition is severe, hypoglycemic drugs are needed. Medications with strong effect are generally preferred to mepyridine, because mepyridine has a short half-life, and more importantly, its metabolites are not biologically active, so it is safer than mepyridine. As for biguanides, even metformin with few side effects should be used with caution, because the elderly may have varying degrees of renal dysfunction. If necessary, the dose of metformin should be less than the average person. ^[2]

Misunderstanding of oral hypoglycemic drugs

1. Ignore diet therapy. Experts point out that some patients do not control their diet and want to take more hypoglycemic drugs to control their condition, which is wrong or even dangerous. Clinical practice fully proves that without reducing the diet, oral hypoglycemic drugs usually fail.

2. Do not adjust the amount of hypoglycemic agents based on blood glucose levels. Experts say that some patients feel safe when they have taken the medicine, and often neglect to adjust the dosage according to their blood sugar level. Such medication will greatly affect the efficacy of the drug.

3. Rarely return to the hospital for a review or examination. Experts have found that some patients rarely return for consultation and do not check their blood glucose, lipids, and blood pressure often. In this way, it is impossible to understand the effect of taking the medicine, nor understand the factors that affect your blood sugar and urine glucose changes.

4. Think that all people taking oral hypoglycemic drugs are effective. Oral hypoglycemic drugs are not effective for everyone, but quite a lot of diabetic patients are unwilling to receive insulin treatment if the oral hypoglycemic drugs are not effective or effective.

5. Eager to change dressings. Some oral hypoglycemic drugs have a gradual increase in the effect of the drug over time in the body. Some patients do not understand this. They often rush to change the medicine after seeing that the blood sugar and urine sugar do not decrease significantly after taking it for a few days. In fact, some hypoglycemic drugs will not reach their maximum hypoglycemic effect until half a month or even a month.

6. It is believed that the price of a drug is directly proportional to its efficacy. Some patients think that low-price hypoglycemic drugs are not effective, and high prices are good medicines. Experts remind that one kind of medicine is better than another, not necessarily reflected in the price, but to see which kind of medicine is more suitable for you.

7. Not paying attention to weight changes. Experts reminded that for patients with severe obesity, weight loss should be reduced first, and then a glucose-lowering drug should be selected according to the blood glucose index. ^[3]

Oral hypoglycemic drug treatment standard

The main purpose of diabetes treatment is to reduce complications. The conclusion of clinical experiments on diabetes control and complications proves that strict blood glucose control can delay the occurrence of complications of diabetes. Although this clinical experiment was obtained with IP-DM patients treated with insulin, controlling the relationship between blood glucose and complications is also applicable to patients with type 2 diabetes. What level of blood glucose control is good, as recommended by a diabetes expert: The ideal level is to control fasting blood glucose below 6 mmol / L (110 mg / dl), and 2 h after a meal below 8 mmol / L (140 mg / dl) , At least less than 8 mmol / L (140 mg / dl) on an empty stomach, less than 10 mmol / L (180 mg / dl) 2 h after a meal, and the elderly should not be higher than 11.1 mmol / L (200 mg / dl) . This level must be reached in order to reduce the complications of diabetes and to reach the therapeutic goals. Various complications are the main causes of disability and premature death in diabetes. For blind treatment, the doctor prescribes the medicine as usual, and the patient takes the medicine as usual, regardless of the effect of the treatment. If the blood sugar does not reach the control level, it means that there is no treatment. Therefore, achieving treatment standards should be the goal of the joint efforts of doctors and patients. ^[2]