[IPSF EMRO] Pharmacist's Letter 1st Edition - World Diabetes Day

Medication

Mechanism of action

Side effects

Alpha-glucosidase inhibitors

Acarbose (Precose) and miglitol (Glyset) are alpha-glucosidase inhibitors. These drugs help the body to lower blood sugar levels by blocking the breakdown of starches.

They should be taken with the first bite of a meal. These drugs may have side effects, including gas and diarrhea.

Biguanides

Metformin (Glucophage) is a biguanide. Biguanides lower blood sugar levels primarily by decreasing the amount of glucose produced by the liver. Metformin helps to lower blood sugar levels by making muscle tissue more sensitive to insulin so glucose can be absorbed.

It is usually taken two times a day. A side effect of metformin may be diarrhea, but this is improved when the drug is taken with food.

Bile Acid Sequestrants

The BAS colesevelam (Welchol) is a cholesterol-lowering medication that also reduces blood sugar levels in patients with diabetes.  BASs help remove cholesterol from the body, particularly LDL cholesterol, which is often elevated in people with diabetes.

They are usually safe for use by patients who may not be able to use other medications because of liver problems. Because of the way they work, the side effects of BASs can include flatulence and constipation.

Dopamine-2 Agonists

Bromocriptine (Cycloset and Parlodel) helps lower blood sugar levels after a meal.

Not relevant

DPP-4 inhibitors

A new class of medications called DPP-4 inhibitors help improve A1C without causing hypoglycemia. They work by preventing the breakdown of a naturally occurring compound in the body, GLP-1. GLP-1 reduces blood sugar levels in the body but is broken down very quickly so it does not work well when injected as a drug.

 None

Meglitinides

Meglitinides are drugs that also stimulate the beta cells to release insulin.

Nateglinide (Starlix) and repaglinide(Prandin) are meglitinides. They are taken before each of three meals.

Because sulfonylureas and meglitinides stimulate the release of insulin, it is possible to have hypoglycemia (low blood sugar levels).

SGLT2 Inhibitors

Glucose in the bloodstream passes through the kidneys, where it can either be excreted or reabsorbed.   Sodium-glucose transporter 2 (SGLT2) works in the kidney to reabsorb glucose, and a new class of medication, SGLT2 inhibitors, block this action, causing excess glucose to be eliminated in the urine.

Canagliflozin (Invokana), dapagliflozin (Farxiga), and empagliflozin (Jardiance) are SGLT2 inhibitors that have been approved by the FDA to treat type 2 diabetes.  Because they increase glucose levels in the urine, side effects can include urinary tract and yeast infections.

Sulfonylureas

Sulfonylureas stimulate the beta cells of the pancreas to release more insulin. . Chlorpropamide (Diabinese) is the only first-generation sulfonylurea still in use today. The second-generation sulfonylureas are used in smaller doses than the first-generation drugs.

  Generally hypoglycemia, weight gain and dark-colored urine.

TZDs(Thiazolidinediones)

Rosiglitazone (Avandia) and pioglitazone (ACTOS) are in a group of drugs called thiazolidinediones. These drugs help insulin work better in the muscle and fat and also reduce glucose production in the liver.

Both drugs appear to increase the risk for heart failure in some individuals, and there is a debate about whether rosiglitazone may contribute to an increased risk for heart attacks. Both drugs are effective at reducing A1C and generally have few side effects.

Sulfonylurea-induced hypoglycemia is worsened by

co-administration with azole antifungals, clarithromycin, verapamil, angiotensin-converting enzyme. (ACE) inhibitors, DPP-4s, and GLP-1 agonists

Metformin toxicity is more likely with

anticholinergics because of increased absorption and nephrotoxic agents. (eg, iodinated contrast media)

Thiazolidinedione toxicity is heightened by

CYP P450 2C8 inhibitors. (eg, ketoconazole, gemfibrozil, rifampicin, fluvoxamine, and trimethoprim)

Saxagliptin concentration is affected by

CYP3A4 inhibitors and inducers and ACE inhibitors increase the risk of bradykinin-induced angioedema.

Ginseng induces CYP3A4

(decreasing glibenclamide, pioglitazone, meglitinides, sitagliptin, and saxagliptin concentrations) and stimulates insulin secretion.

St. John’s wort induces CYP3A4, 1A2, 2D6, and 2E1

(decreasing sulfonylureas, thiazolidinediones, meglitinides, and DPP-4 inhibitors) and induces p-glycoprotein pumps.

Sulfonylureas, thiazolidinediones, and meglitinides are affected by

hepatic enzyme interactions, metformin toxicity is mediated by nephrotoxicity, and dipeptidyl-peptidase-4 inhibitors are less affected by hepatic enzymes. between antidiabetics and other meds.

TYPE 1 DIABETES

TYPE 2 DIABETES

• Insulin is important in Type 1 diabetes. However, if it is used improperly, efficacy and safety can be issues. Key counseling points for patients injecting insulin are proper administration and hypoglycemia treatment. Additionally, pharmacists should be aware of adjunctive therapy for Type 1 diabetes either on or off official authorization.

• Research is now showing that significant weight loss can reverse Type 2 diabetes.
•  This is exciting news and provides good reasons to make changes to your lifestyle.
• Diabetes is treated and delayed by:

*Healthy eating to lose weight if overweight

*Being more physically active (at least 30 minutes of physical activity per day)

*Avoiding smoking

(this part is for both type 1 and type 2)

For Nutrition :

Eating doesn’t have to be boring. It’s all about finding the right balance that works for you.

When you’re managing diabetes, eating healthy can feel boring and dull, right? Don’t give up! The one key to feeling your best lies in the food you eat:

• Start working with a dietitian or registered dietitian nutritionist (RDN) or your loved ones to make an eating plan today. Be sure to include foods you like and don’t be afraid to try something new.
• Remember that eating well and exercising in your daily routine are important ways to help you manage diabetes.