Type II Diabetes and its Most Common Drug List

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type ii diabetes and its most common drug list

Introduction

Diabetes is increasingly becoming a global epidemic with nearly 422 million people suffering from the disease. It is projected to emerge as one of the leading causes of death by the year 2030.[1] Diabetes is a chronic condition in which the blood glucose level remains above normal for a prolonged period of time. It can occur when pancreas does not produce enough insulin, leading to Type I diabetes, or, when the cells become resistant to the insulin produced by the body, causing Type II diabetes. Insulin is a hormone which facilitates the entry and utilization of glucose by the cells. Since the cells become resistant to the insulin produced by the body in type II diabetes, glucose is unable to enter the cells, leading to increased blood glucose levels. Hyperglycemia or increased blood glucose levels can cause serious damage to our nervous system and cardiovascular system.

Type II diabetes is largely caused due to unhealthy lifestyle and physical inactivity, leading to excess body weight. Until recently, it was a disease of the elderly, but now, it can be seen even in young adults.

By taking care of our diet, exercising regularly and maintaining a healthy weight, you can easily manage diabetes. If you are unable to keep your blood glucose levels under control through lifestyle changes, then medicines will be prescribed.

Symptoms

Symptoms of Type II diabetes are as follows:

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  • Increased thirst and frequent urination
  • Increased appetite
  • Weight loss
  • Fatigue
  • Blurred vision
  • Frequent infections
  • Patches of darkened skin

Treatment

There is a wide spectrum of medicines available for managing Type II diabetes. The treatment is aimed at eliminating the symptoms of high blood glucose levels while delaying or preventing the development of complications due to the disease. Every stone is turned to keep blood sugar level within limits. Apart from taking your medicines religiously, you are required to follow a proper diet and a healthy lifestyle with regular exercise to keep your blood glucose level under control.

Alpha-glucosidase inhibitors, biguanides, dipeptidyl-peptidase-4 (DPP-4) inhibitors, meglitinides, sulphonylureas, thiazolidinediaone, glucagon-like peptide-1 (GLP-1) agonists, glycosurics or selective sodium glucose co-transporter-2 (SGLT-2) inhibitors are the different drug classes that will help you in keeping your glucose within normal range. They are explained below.

a) Alpha-Glucosidase Inhibitors

The drugs belonging to this class help in prolonging the absorption of carbohydrates in the gut and therefore prevent postprandial increase in glucose levels in the body. These drugs induce flatulence and need to be titrated slowly to decrease gut intolerance. They have limited usefulness in managing blood glucose levels.

Drug: acarbose
Brand name: Precose
The U.S. FDA Status: Approved
Availability: Prescription only
Dosage Form: Tablet
Indicated in Pregnancy: Yes, under continuous monitoring
Alcohol Content: No
Side Effects: Abdominal pain, bloating, diarrhea, nausea, vomiting, dyspepsia, jaundice, thrombocytopenia, rash, utricaria and edema

Drug: miglitol
Brand name: Glyset
The U.S. FDA Status: Approved
Availability: Prescription only
Dosage Form: Tablet
Indicated in Pregnancy: Yes, under continuous monitoring
Alcohol Content: No
Side Effects: Abdominal pain, diarrhea, flatulence, decreased serum iron, skin rash and bloating

b) Biguanides

These drugs are considered the first choice of treatment for managing diabetes type II through oral medication. They prevent the synthesis of glucose from non-carbohydrate sources in liver. decrease intestinal absorption of glucose and increase insulin sensitivity of body cells. These drugs are absorbed from the intestine and are rapidly excreted through urine. When used alone, these seldom cause hypoglycemia.

Drug: metformin
Brand names: Glucophage
The U.S. FDA Status: Approved
Availability: Prescription only
Dosage Form: Tablet
Indicated in Pregnancy: Yes, only if clearly needed
Alcohol Content: No
Side Effects: Lactic acidosis, cough or hoarseness, diarrhea, abdominal pain, nausea, vomiting, decreased vitamin B12 serum concentrate, fever, general feeling of discomfort, muscle pain and sleepiness

c) Dipeptidyl-peptidase-4 (DPP-4) Inhibitors

Incretins are hormones that are secreted by the endocrine cells located in small intestine. They stimulate secretion of insulin in response to meals and therefore, play an important role in maintaining blood glucose levels. They also decrease glucagon levels in the blood. DPP-4 causes degradation of these incretins. Therefore, DPP-4 inhibitors are prescribed to prolong the action of incretins, which eventually lead to lowering of blood glucose levels.

Drug: sitagliptin
Brand Name: Januvia
The U.S. FDA Status: Approved
Availability: Prescription only
Dosage Form: Tablet
Indicated in Pregnancy: Yes, only if clearly needed
Alcohol Content: No
Side Effects: Anxiety, blurred vision, chills, cold sweats, confusion, depression, headache, nausea, seizures, slurred speech and unusual tiredness

Drug: saxagliptin
Brand Name: Onglyza
The U.S. FDA Status: Approved
Availability: Prescription only
Dosage Form: Tablet
Indicated in Pregnancy: Yes, only if clearly needed
Alcohol Content: No
Side Effects: Anxiety, blurred vision, chills, cold sweats, confusion, depression, headache, nausea, seizures, slurred speech and unusual tiredness

Drug: linagliptin
Brand Name: Tradjenta
The U.S. FDA Status: Approved
Availability: Prescription only
Dosage Form: Tablet
Indicated in Pregnancy: Yes, only if clearly needed
Alcohol Content: No
Side Effects: Anxiety, blurred vision, chills, cold sweats, confusion, depression, headache, nausea, seizures, slurred speech and unusual tiredness

Drug: Alogliptin
Brand Name: Nesina
The U.S. FDA Status: Approved
Availability: Prescription only
Dosage Form: Tablet
Indicated in Pregnancy: Yes, only if clearly needed
Alcohol Content: No
Side Effects: Upper respiratory tract infection, nasopharyngitis, headache, anxiety, blurred vision, chills, cold sweats, confusion, depression, headache, nausea, seizures, slurred speech and unusual tiredness

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d) Meglitinides

These are short acting drugs that act as insulin secretagogues, i.e. they increase insulin secretion from the pancreas. They are generally meant to be taken before meals so as to induce insulin secretion. Drugs belonging to this class pose less danger of hypoglycemia.

Drug: repaglinide
Brand Name: Prandin
The U.S. FDA Status: Approved
Availability: Prescription only
Dosage Form: Tablet
Indicated in Pregnancy: No, unless benefits outweigh risks
Alcohol Content: No
Side Effects: Hypoglycemia, anxiety, blurred vision, chills, cold sweats, confusion, depression, headache, nausea, seizures, slurred speech and unusual tiredness

Drug: nateglinide
Brand Name: Starlix
The U.S. FDA Status: Approved
Availability: Prescription only
Dosage Form: Tablet
Indicated in Pregnancy: No, unless benefits outweigh risks
Alcohol Content: No
Side Effects: Hypoglycemia, anxiety, blurred vision, chills, cold sweats, confusion, depression, headache, nausea, slurred speech and unusual tiredness

e) Sulphonylureas

These drugs act as insulin secretagogues which induce secretion of insulin from the pancreas and improve its effectiveness in the body. They are also known to reduce HbA1C levels by 1-2% and blood glucose levels by nearly 20%.

Drug: glyburide/ glibenclamide
Brand Name: DiaBeta
The U.S. FDA Status: Approved
Availability: Prescription only
Dosage Form: Tablet
Indicated in Pregnancy: No, unless benefits outweigh risks
Alcohol Content: No
Side Effects: Difficulty in swallowing, dizziness, hives, fast heartbeat, itching, shortness of breath, tightness in chest, wheezing, fatigue and skin rash

Drug: glipizide
Brand Name: Glucotrol
The U.S. FDA Status: Approved
Availability: Prescription only
Dosage Form: Tablet
Indicated in Pregnancy: No, unless benefits outweigh risks
Alcohol Content: No
Side Effects: Anxiety, blurred vision, chills, cold sweats, confusion, depression, headache, nausea, slurred speech and unusual tiredness

Drug: glimepiride
Brand Name: Amaryl
The U.S. FDA Status: Approved
Availability: Prescription only
Dosage Form: Tablet
Indicated in Pregnancy: No, unless benefits outweigh risks
Alcohol Content: No
Side Effects: Difficulty in swallowing, dizziness, hives, fast heartbeat, itching, shortness of breath, tightness in chest, wheezing, fatigue and skin rash

f) Thiazolidinediaone

These are the drugs that reduce insulin resistance in body cells, including liver. They sensitize fat and muscles to the action of insulin. They are responsible for activating a factor, responsible for fat cell differentiation and fatty acid metabolism, known as peroxisome proliferator -activated receptor (PPAR) gamma. Fat redistribution is probably the major action of thiazolidinediones. These drugs are also supposed to have beta-cell preservation properties, which delay or prevent progression of diabetes.

Drug: pioglitazone
Brand Name: Actos
The U.S. FDA Status: Approved
Availability: Prescription only
Dosage Form: Tablet
Indicated in Pregnancy: No, unless benefits outweigh risks
Alcohol Content: No
Side Effects: Upper respiratory tract infection, hypoglycemia, edema, bone fracture, headache, pharyngitis, cardiac failure, chest pain, decreased urine output, dilated neck veins, extreme fatigue, irregular breathing, teeth problems, weight gain and trouble breathing

Drugs: rosiglitazone
Brand Name: Avandia
The U.S. FDA Status: Approved
Availability: Prescription only
Dosage Form: Tablet
Indicated in Pregnancy: No, unless benefits outweigh risks
Alcohol Content: No
Side Effects: Abdominal pain, blurred vision, chest pain, dry mouth, decreased urine output, flushed, fruit-like breath odor, increased hunger and thirst, nausea, noisy breathing, sweating and weight loss

g) Glucagon-like peptide-1 (GLP-1) Agonists

These are the drugs that mimic the action of incretins in the body. Incretins are endogenous hormones secreted by endocrine cells found in the intestinal wall. There are two types of incretins secreted, namely, glucose-dependent insulinotropic peptide (GIP) and glucagon-like peptide-1 (GLP-1). They cause glucose dependent insulin release in the body as opposed to insulin sectretagogues which may cause insulin release even in the absence glucose. These drugs also reduce glucagon blood levels and delay gastric emptying.

Drug: exetanide
Brand Name: Byetta
The U.S. FDA Status: Approved
Availability: Prescription only
Dosage Form: Subcutaneous injection
Indicated in Pregnancy: No, unless benefits outweigh risks
Alcohol Content: Traces
Side Effects: Agitation, bloating, chills, confusion, constipation, cough, darkened urine, depression, dizziness, dry mouth, fainting, fever, headache, increased heart rate, indigestion, irritability and nausea

Drug: liraglutinide
Brand Name: Victoza
The U.S. FDA Status: Approved
Availability: Prescription only
Dosage Form: Subcutaneous injection
Indicated in Pregnancy: No
Alcohol Content: Yes
Side Effects: Bladder pain, bloody urine, chills, cough, diarrhea, painful urination, fever, headache, joint pain, loss of appetite, muscle pain, nausea, runny nose, shivering, vomiting, sweating and trouble sleep

Drug: albiglutide
Brand Name: Tanzeum
The U.S. FDA Status: Approved
Availability: Prescription only
Dosage Form: Injectable
Indicated in Pregnancy: No, unless benefits outweigh risks
Alcohol Content: Traces
Side Effects: Injection site reaction, diarrhea, nausea, vomiting, bloating, chills, darkened urine, fast heartbeat, loss of appetite, nausea, confusion, anxiety, blurred vision and cold sweats

Drug: dulaglutide
Brand Name: Trulicity
The U.S. FDA Status: Approved
Availability: Prescription only
Dosage Form: Injectable
Indicated in Pregnancy: No,unless benefits outweigh risks
Alcohol Content: Yes
Side Effects: Agitation, chills, change in urination, cold sweats, confusion, depression, dizziness, fast heartbeat, fever, hives, irritability, lethargy and loss of appetite and rapid weight gain

Drug: lixisenatide
Brand Name: Adlyxin
The U.S. FDA Status: Approved
Availability: Prescription only
Dosage Form: Subcutaneous solution
Indicated in Pregnancy: No,unless benefits outweigh risks
Alcohol Content: Traces
Side Effects: Anxiety, bloating, blurred vision, chills, cold sweats, confusion, constipation, cough, darkened urine, depression, dizziness, fainting, fast heartbeat, headache, nausea, nightmares, shakiness and slurred speech

Drug: semaglutide
Brand Name: Ozempic
The U.S. FDA Status: Approved
Availability: Prescription only
Dosage Form: Subcutaneous solution
Indicated in Pregnancy: No,unless benefits outweigh risks
Alcohol Content: No
Side Effects: Abdominal pain, fever, stomach fullness, yellow eyes, indigestion, stomach upset, anxiety, blurred vision, chills, cold sweats, nausea, nightmares, nervousness, headache and irritability

h) Glycosurics or Selective Sodium Glucose Co-Transporter-2 (SGLT-2) Inhibitors

Drugs belonging to this class block glucose re-uptake in the renal tubules of kidneys, thereby increasing the excretion of glucose from the body. These drugs have a minor chance of developing hypoglycemia.

Drug: canagliflozin
Brand Name: Invokana
The U.S. FDA Status: Approved
Availability: Prescription only
Dosage Form: Tablet
Indicated in Pregnancy: No, unless benefits outweigh risks
Alcohol Content: No
Side Effects: Vulvovaginal candidiasis, vaginal infection, vulvitis, vulvovaginitis, decreased mean glomerular filtration rate, increased urine output, nocturia, urinary urgency, bladder pain, bloody urine, nausea, increased thirst, weight gain and vaginal discharge with odor

Drug: dapagliflozin
Brand Name: Farxiga
The U.S. FDA Status: Approved
Availability: Prescription only
Dosage Form: Tablet
Indicated in Pregnancy: No
Alcohol Content: No
Side Effects: Cystitis, pyelonephritis, urinary tract infection, vulvovaginal candidiasis, bacterial vaginosis, genital candidiasis, genitourinary infection, prostatitus, urethritis, vaginal infection, vulvitis and vulvovaginitis, anxiety, bladder pain, chills, cold sweats, confusion, depression and dizziness

Drug: empagliflozin
Brand Name: Jardiance
The U.S. FDA Status: Approved
Availability: Prescription only
Dosage Form: Tablet
Indicated in Pregnancy: No
Alcohol Content: No
Side Effects: Urinary tract infection, cervicitis, genital candidiasis, vaginal infection, vulvitis, vulvovaginitis, genitourinary infection, bladder pain, bloody urine, itching in vaginal area, anxiety, bloating, blurred vision, chills, cold sweats, confusion, constipation, cough, darkened urine, depression, dizziness, fainting, fast heartbeat, headache, nausea, nightmares, shakiness and slurred speech

OTC Drugs Used

There are no OTC drugs available for managing type II diabetes.