Oral Anti Diabetic:

a) AGIs
b) Biguanides
c) Dipeptidyl peptidase-4 (DPP-4) Inhibitors
d) Insulin Secretagogues – SUs
– Non-SUs or Meglitinides
e) Thiazolidinediones (TZDs)

A) a-glucosidase inhibitor
1) Mode of Action (M.O.A) :
i) @ epith. Of proximal small intestine : ↓ a-glucosidase enzyme →↓ digestion of
Polysaccharides
ii) °hypoglycemia, only ↓postprandial glucose
iii) effectiveness < metformin/ SU.
iv) Synergy other OAD / insulin

2) Side Effect (S/E) :

I) bloating ii) Abd. Discomfort iii) Diarrhea
iv) Flatulence

3) treatment for S/E : monosaccharides (glucose)

4) Dose : usual : 50-100mg/meal , max : 100mg TDS

B) a-glucosidase inhibitor
1) M.O.A:
i) °↑ insulin secretion; °hypoglycemia: ↓ hepatic glucose production
ii) 1st line in obese pt.
iii) ↓ plasma glucose up to 20% : HBA1C by 1.5%
iv) Synergy other OAD .
V) ↑ insulin sensitivity + ↓ insulin requirement

2) Side Effect (S/E) :

I) nausea ii) Anorexia iii) Diarrhea iv) Lactic
Acidosis ( rare) v) Vit. B12 Def - ?Patial gastrectomy / ?Terminal ileal dis.

3) treatment for S/E : use extended release formula

4) Benefit : i) Weight loss/Stability ii) improve heart disease

5) Dose :
Metformin : usual : 500mg/tds , max : 10o0mg BDS
slow release : usual : 850mg/bds , max : 1700mg OM/ 850 ON
extended release : start : 500mg/ods , max : 2000mg od
Glibenclamide+metofrmin : start : 1.25mg+250mg/OD@BD max : 5mg+250mg BDs
6) Contraindication (C/I):
I) ↓ Renal func. II) CHF III) Live Cirrhosis
IV) recent MI V) Chronic Resp. Dis. VI) Vascular Dis.
VII) Severe Inf.

c) Dipeptidyl peptidase-4 (DPP-4) Inhibitor (Sitagliptin)

1) M.O.A:
I) ↑ incretin → ↓glucagon →↑ insulin →↓ gastric emptying + ↓blood glucose
ii) equivelant glycaemic efficacy with glipizide
iii) ↓ HBA1C by 0.5-0.8%
iv) Cumulative efficacy with other OAD .
V) reduce dose if there is renal impairment ( excreted unchanged)

2) Benefit : i) minimal risk hypoglycemia + weight neutrality

3) Dose :
Sitagliptin : start : 100mg/ods , max : 100mg ODS
Sitagliptin + metformin : start : 50mg+500mg bds , max : 50mg+1000mg bds

d) Insulin Secretagouge (SUs)

1) M.O.A:
i) ↑ insulin secretion; ↓ plasma glucose
ii) take 30 minutes before meals, except glimepiride and gliclazide MR;
can take just before the meal.
iii) ↓ plasma glucose up to 25% : HBA1C by 1.5%
iv) Can combine with other OAD/Control : ↑ glucose control
V) Don’t combine 2 SUs

2) Side Effect (S/E) :

I) HYPOGLYCEMIA , ↑ with renal impairment, Chirrosis, elderly
ii) hepaitits iii) SIADH iv) blood dyscrasias

3) treatment for S/E : use extended release formula

4) Benefit : i) Weight loss/Stability ii) improve heart disease

7) Dose :
Metformin : usual : 500mg/tds , max : 10o0mg BDS
slow release : usual : 850mg/bds , max : 1700mg OM/ 850 ON
extended release : start : 500mg/ods , max : 2000mg od
Glibenclamide+metofrmin : start : 1.25mg+250mg/OD@BD max : 5mg+250mg BDs

8) Contraindication (C/I):
I) ↓ Renal func. II) CHF III) Live Cirrhosis
IV) recent MI V) Chronic Resp. Dis. VI) Vascular Dis.
VII) Severe Inf.