Oral Agents for Diabetic Management Guide
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This document provides information on oral agents for diabetic management. It discusses the types of diabetes, targets for treatment, and classes of oral antidiabetic drugs including their mechanisms and side effects. Metformin is recommended as first-line treatment for type 2 diabetes. Sulfonylureas increase insulin secretion but can cause hypoglycemia. Acarbose reduces postprandial glucose levels. Combination therapy or adding basal insulin may help achieve better glycemic control for patients not at target on oral agents alone. Proper use of medication including right drug, dose, administration method and timing is important for effective management of diabetes.
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Oral Agents for Diabetic Management Guide
- 1. ORAL AGENTS FOR DIABETIC MANAGEMENT Prepared by : Cik Hema Latha Sinniah Pegawai Farmasi U41 Klinik Kesihatan Sungai Besar
- 2. DIABETES A chronic metabolic disorder characterised by a high blood glucose concentration- hyperglycaemia fasting plasma glucose > 7.0 mmol/l, or plasma glucose> 11.1 mmol/l 2 hours after a meal caused by insulin deficiency insulin resistance
- 3. TARGETS FOR TYPE 2 DIABETES MELLITUS Glycemic control Levels Fasting 4.4-6.1 mmol/L Non fasting 4.4-8.0 mmol/L HbA1c < 6.5% Lipids Levels Triglycerides ≤ 1.7 mmol/L HDL cholesterol ≥ 1.1 mmol/L LDL cholesterol ≤2.6 mmol/L Exercise 150 mins/week Blood pressure Levels Normal Renal Function ≤130/80 mmHg Renal Impairment/Gross Proteinuria ≤125/75 mmHg
- 4. TYPES OF DIABETES Type 1 (Juvenile-Onset) Type 2 (Adult-Onset) Other types including: - Gestational diabetes - MODY (maturity onset diabetes of the young) - LADA (latent auto-immune diabetes of adults) - Others
- 5. CAUSE OF TYPE 1 DM Auto-immune destruction of insulin-producing β-cells in the pancreas
- 6. CAUSE OF TYPE 2 DM Insulin resistance (genetics) - aggravated by obesity - aggravated by lack of exercise “Exhaustion” of insulin-producing β-cells
- 7. MAJOR METABOLIC DEFECTS IN TYPE 2 DIABETES Peripheral insulin resistance in muscle and fat Decreased pancreatic insulin secretion Increased hepatic glucose output Haffner SM, et al. Diabetes Care, 1999
- 8. ORAL ANTIDIABETIC AGENTS: Agents that are given orally to reduce the blood glucose levels in diabetic patients Five types of oral antidiabetic drugs are currently in use: • Biguanides :metformin • Sulfonylureas: glimepiride, gliclazide, glyburide, tolbutamide, glibenclamide, glipizide • Meglitinides : nateglinide, repaglinide • Thiazolidinediones : pioglitazone, rosiglitazone Alpha -glucosidase inhibitors: acarbose, miglitol
- 9. The oral antidiabetic drugs are of value only in the treatment of patients with type 2 (NIDDM) diabetes mellitus whose condition cannot be controlled by diet alone. These drugs may also be used with insulin in the management of some patients with diabetes mellitus, Use of an oral antidiabetic drug with insulin may decrease the insulin dosage in some individuals.
- 10. METFORMIN (BIGUANIDES) does not stimulate insulin secretion increase glucose uptake and utilisation in skeletal muscle (thereby reducing insulin resistance) and reduce hepatic glucose production (gluconeogenesis). First line drug treatment in overweight/obese patients. will lower HbA1c by about 1.5%. Usually not accompanied by hypoglycemia
- 11. Contra indications -Metformin should not be given to patients with Renal failure Hepatic disease Hypoxic pulmonary disease Heart failure or shock
- 12. GLIBENCLAMIDE AND GLICLAZIDE (SULFONYLUREAS) Works by increasing insulin secretion. can lower plasma glucose by up to 25% lower HbA1c by about 1.5%. SUs should be taken 30 minutes before meals Combining two different sulfonylurea is not recommended Long acting sulfonylurea (i.e Glibenclamide) associated with greater risk of hypoglycemia.
- 13. ACARBOSE -ALPHA-GLUCOSIDASE INHIBITOR (AGI) Act at the gut epithelium, to reduce the rate of digestion of polysaccharides in small intestine. primarily lower postprandial glucose without causing hypoglycemia Patients receiving insulin or SUs as well as acarbose need to carry glucose to counteract possible hypoglycemia. Need to be taken together with food.
- 14. BEFORE INITIATING INSULIN: Before considering to start patient on insulin, there are a few points that needs to be considered: Patient’s compliance towards current medication Patient’s age Patient’s other comorbidities Patient’s diet control and lifestyle Patient’s agreement
- 15. PROACTIVE MANAGEMENT OF GLYCAEMIA: EARLY COMBINATION APPROACH OAD + basal insulin OAD + multiple daily insulin injections Diet OAD monotherapy OAD combinations OADs up-titration Duration of diabetes 7 6 9 8 HbA1c(%) 10
- 16. TYPES OF INSULIN Short-acting Actrapid, Humulin R Intermediate-acting Insulatard, Humulin N Biphasic Mixtard, Humulin 30/70 Long-acting Insulin Glargine, Monotard
- 18. UBAT YANG BETUL PENGGUNA UBAT YG BETUL MASA YANG BETUL CARA PENGAMBILAN YANG BETUL DOS YANG BETUL
- 19. PENGGUNA UBAT YANG BETUL UBAT YANG BETUL DOS YANG BETUL CARA PENGAMBILAN YANG BETUL MASA YANG BETUL B B B B B
- 21. PENGGUNA UBAT YANG BETUL UBAT YANG BETUL DOS YANG BETUL CARA PENGAMBILAN YANG BETUL MASA YANG BETUL B B B B B
- 22. SAYA MENGIDAP PENYAKIT GASTRIK. INILAH UBAT UNTUK PENYAKIT SAYA
- 23. PENGGUNA UBAT YANG BETUL UBAT YANG BETUL DOS YANG BETUL CARA PENGAMBILAN YANG BETUL MASA YANG BETUL B B B B B
- 25. PENGGUNA UBAT YANG BETUL UBAT YANG BETUL DOS YANG BETUL CARA PENGAMBILAN YANG BETUL MASA YANG BETUL B B B B B
- 26. CARA PENGAMBILAN BENTUK DOSEJ CARA PENGAMBILAN MIXTURE/ SYRUP MINUM SEPERTI DIARAHKAN LOTION/ KRIM SAPU PADA TEMPAT YANG MENGALAMI MASALAH SAJA SEPERTI DIARAHKAN SUPPOSITORI MASUKKAN KE DALAM DUBUR SEPERTI DIARAHKAN INHALER / TURBOHALER GUNAKAN MENGIKUT TEKNIK YANG BETUL TABLET/ KAPSUL TELAN. JANGAN KUNYAH ATAU HANCURKAN JIKA TIDAK DIARAHKAN.
- 27. PENGGUNA UBAT YANG BETUL UBAT YANG BETUL DOS YANG BETUL CARA PENGAMBILAN YANG BETUL MASA YANG BETUL B B B B B
- 28. SEKALI SEHARI SETIAP 24JAM WAKTU YANG SAMA SETIAP HARI. MALAM @ SIANG 2 KALI SEHARI SETIAP 12JAM CTH: 8 PAGI, 8 MALAM 3 KALI SEHARI SETIAP 8JAM CTH: 6 PAGI, 2 PETANG, 10 MALAM 4 KALI SEHARI SETIAP 6JAM CTH: 6 PAGI, 12 TGH, 6 PTG, 12 MLM BILA PERLU DIAMBIL BILA DIPERLUKAN SAJA CTH: BILA SAKIT, BILA ADA SERANGAN ASTHMA MASA PENGAMBILAN/ PENGGUNAAN UBAT
- 29. THANK YOU FOR YOUR ATTENTION