Type 2 Diabetes: Commonly Used Medications

Definition: Type 2 Diabetes Mellitus (was previously called NIDDM: Non-insulin dependent diabetes). This type of obesity is either due to insulin resistance, insulin deficiency and/or hyperglycemia. The underlying cause is polygenic (meaning that multiple genes are responsible) however the genes are not able to express themselves if the following factors are absent: a. obesity b. and lack of exercise.

Obesity is the major cause of type 2 diabetes. This man made disorder costs the U.S. health system and extra $22.9 billion annually in direct medical costs. Opportunity and individual costs were not considered. Rough estimates would easily double the total costs.

21 million Americans suffer from type 2 diabetes, mostly the result of adult onset obesity. Globally 5% of all annual deaths are due to type 2 diabetes which is caused by adult onset obesity.

Reduced caloric intake and increased physical activity are the preferred choices in the management of diabetes type 2. However, when these interventions fail medical intervention becomes the next best option. Many medications are used but the fall into five important categories:

1. Oral sulfonylureas: These are pancreatic stimulants which act on the Islets of Langerhans to produce more insulin. Examples of medications which belong to this group include: Glimepiride, Glyburide, and Tolazamide. This list is not all exhaustive and new drugs are continually being developed and added to this list. All of these medications are taken orally and are adjusted according the patient’s needs.
2. Biguanides :This group of medications act on the liver by decreasing the production of glucose. The net result is a decrease in glucose levels in the blood stream. Example: Metformin.
3. Alpha-glucosidase inhibitors: These medications decrease the absorption of simple and complescarbohydrates from the digestive tract. Their net effect is to lower the “after-meal glucose levels”. Example: Acarbose.
4. Thiazolidinediones: These medications help by increasing the efficiency of insulin. Thiazolidinediones increase the cell’s sensitivity / responsiveness. The exact mechanism is not clearly understood. Example: Rosiglitazone.
5. Meglitinides: This group of oral hypoglycemic agents triggers the pancreas to produce more insulin in response to how much glucose there is in the blood. Examples: Repaglinide, Nateglinide.

If the patient continues to have poor blood glucose control despite lifestyle changes and the commencement of these medications it may be necessary to commence the patient on insulin.

Poorly controlled diabetes can be life threatening.