Short summary of the management of type 2 Diabetes Mellitus

1. Treatment of diabetes Mellitus T2 from view
point of cardiology link
Samir Rafla
Emeritus professor of Cardiology,
Alexandria University, Faculty of Medicine,
Cardiology Department. Egypt.

2. Management of type 2 diabetes includes:
- Weight loss
- Healthy eating
- Regular exercise
- Blood sugar monitoring
- Possibly, diabetes medication or insulin therapy

3. • These steps will help keep your blood sugar level closer to normal, which can
delay or prevent complications. Weight loss:
1 Losing weight can lower your blood sugar levels. Losing just 5 to 10 percent of
your body weight can make a difference.
2 Healthy eating: Contrary to popular perception, there's no specific diabetes
diet. However, it's important to center your diet around:
• Fewer calories. Fewer refined carbohydrates, especially sweets
• Fewer foods containing saturated fats
• More vegetables and fruits. More foods with fiber

4. • 3 Physical activity: Aim for at least 30 to 60 minutes of moderate (or
15 to 30 minutes of vigorous) aerobic exercise most days of the
week. Remember that physical activity lowers blood sugar. It's also
important to reduce the amount of time you spend in inactive
activities, such as watching TV. Try to move around a bit every 30
minutes.
• 4 Monitoring your blood sugar:
• 5 Diabetes medications and insulin therapy

5. • Oral Drugs for Diabetes:
• Each class of medicine works in different ways to lower blood
sugar. A drug may work by:
• Stimulating the pancreas to produce and release more insulin
• Inhibiting the production and release of glucose from the liver
• Blocking the action of stomach enzymes that break down
carbohydrates
• Improving the sensitivity of cells to insulin
• Inhibiting the reabsorption of glucose in the kidneys

6. • Biguanides
• Medications: Metformin (Glucophage, others)
• Action: Inhibit the release of glucose from the liver, Improve
sensitivity to insulin
• Advantages: Very effective, May promote modest weight loss, Low
cost
• Possible side effects: Nausea, Diarrhea,
Very rarely, the harmful buildup of lactic acid (lactic acidosis) when
used in patients with kidney or liver failure.

7. Sulfonylureas. These medications help your body secrete more insulin.
Medications
 Glipizide
 Gliclazise (Diamicron)
 Glimepiride (Amaryl, Glimet, Glaryl, Dolcyl)
 Glyburide , Glibeneclamide ( Daonil )
Action
 Stimulate the release of insulin
Advantages
 Low cost
 Effective in lowering blood sugar
Possible side effects: Hypoglycemia,
 Weight gain; Skin rash

8. Thiazolidinediones
Medications: Pioglitazone (Actos)
Action: Improve sensitivity to insulin
 Inhibit the release of glucose from the liver
Advantages
 May slightly increase high-density lipoprotein (HDL), or "good"
cholesterol
Possible side effects
 Weight gain, Heart failure, Heart attack
 Fractures, Possible increased risk of bladder cancer with pioglitazone
These medications shouldn't be used in people with kidney disease or heart
problems.

9. Meglitinides.
These medications — such as repaglinide (Gluconorm,
Novonorm – Novo Nordisk- 0.5, 1, 2 mg tablets ) and
Nateglinide (Starlidine 60, 120 mg ) — work like
sulfonylureas by stimulating the pancreas to secrete
more insulin, but they're faster acting.

10. DPP-4 inhibitors. Dipeptidyl-peptidase 4 (DPP-4) inhibitors
Medications:
- Vildagliptin (Galvus, Galvus met, Vildagluse, Vildagluse plus,
Icandra)
- Saxagliptin (Onglyza, )
- Sitagliptin (Januvia)
- Linagliptin (Tradjenta, Linajenta 5 mg)
- Alogliptin
Action
 Stimulate the release of insulin when blood glucose is rising
 Inhibit the release of glucose from the liver

11. Advantages
 Don't cause weight gain
 Don't cause hypoglycemia (unless combined with insulin
or a sulfonylurea)
Possible side effects
 Upper respiratory tract infection
 Sore throat
 Headache

12. Alpha-glucosidase inhibitors
Medications
 Acarbose (Glucobay 50, 100 mg )
 Miglitol ( )
Action
 Slow the breakdown of starches and some sugars
Advantages
 Don't cause weight gain
 Don't cause hypoglycemia (unless combined with insulin or a
sulfonylurea)
Possible side effects
 Stomach pain
 Gas; Diarrhea

13. GLP-1 receptor agonists.
Examples of GLP-1 receptor agonists: Exenatide ( ), liraglutide
(Victoza- Novo Nordisk 3ml pre filled pen s.c.) and semaglutide ( )
These injectable medications slow digestion and help lower blood
sugar levels. Their use is often associated with weight loss.
Possible side effects include nausea and an increased risk of
pancreatitis. are.

14. Sodium-glucose transporter 2 (SGLT2) inhibitors
Medications
 Dapagliflozin (Forxiga-AstraZeneca. 10 mg tab)
 Empagliflozin (Jardiance (Boehringer Ingelheim), Glimpacare,
Mellitofix, Mellitofix Met).
 Canagliflozin (Invokana- Janssen Cilag=Soficopharm 100 mg tab)
Action: These drugs prevent the kidneys from reabsorbing sugar
into the blood. Instead, the sugar is excreted in the urine (Block
glucose from being reabsorbed by the kidneys)

15. Advantages:
Medications in this drug class may reduce the risk of heart attack
and stroke in people with a high risk of those conditions. May
promote weight loss, May lower blood pressure
Possible side effects:
 Urinary tract infections
 Yeast infections
 Rare, serious genital infection, low blood pressure, and a higher
risk of diabetic ketoacidosis.

16. Group Name Trade name Company Price
Biguanides Metformin Glucophage
Glucophage XR
Cidophage
1000 mg, 30 tab =
Sulfonylureas
Gliclazide Diamicron Servier 60 mg 30 tab 50.25L
Glimepiride (Amaryl) Sanofi 2 mg 30-tab 42 L
2/500 -30-tab 45 L
Glimet
Glaryl
Marcyrl
Global Napi
2.5/40; 5/800 -30 tab 22, 27 L
Glyburide
Thiazolidinediones Pioglitazone Actos
Table- Anti Diabetic drugs (short list)

17. Dipeptidyl-peptidase 4 (DPP-4) inhibitors
Vildagliptin Galvus
Galvus met
Novartis 50 mg 28-tab 137 L
Vildagliptin Gliptus
Gliptus plus
EVA Pharma 50 mg 30 tab 104
50/1000 mg 30-tab 104L
Icandra Mash Premier 50 mg 30-tab 69
Sitagliptin (Januvia)
Janumet
Merck Sharp &
Dohme
50 mg 28 t/b 220 L
50/1000- 56 tab 220;308 L
Linagliptin (Tradjenta) Boehringer
Ingelheim
5mg 30 tab- 235; 329L
Glimbacare MultiCare 21-tab 160.5 L
Saxagliptin Onglyza Bristol Myers
Squibb

18. Sodium-glucose transporter 2 (SGLT2) inhibitors
Dapagliflozin (Forxiga) AstraZeneca 10 mg 30 tab/box 333 L
Empagliflozin (Jardiance) Boehringer
Ingelheim
25 mg 30 t/b 496.5 L
Glimbacare MultiCare 21-tab 160.5 L
Mellitofix EVA pharma 25 mg 30 t/b 297 L
Mellitofix Met EVA pharma 12.5/1000 30 t/b 171 L