Anti-diabetic medication
An anti-diabetic drug (plural antidiabetics) is a medication for the treatment of diabetes mellitus.
There are several groups of compounds with various mechanisms of action and application areas. A basic distinction between insulinotropic (beta- zytotrop ) and non- insulinotropic ( non- beta- zytotrop ) medications.
Insulinotropic substances: These cause the beta cells of the pancreas, insulin secretion, and thus treat a Sekretionsdefizit. The effect may decrease at later stages of the disease, since the function of the beta cell with increasing disease duration may decrease.
- Sulfonylureas
- Glinides
- DPP -4 inhibitors
- Inkretinmimetika
Non- insulinotropic substances: These act in the periphery and treat insulin resistance (eg, metformin) or delay the glucose absorption from the intestine (a- glucosidase inhibitors). There is no risk of hypoglycemia, and the drugs are particularly useful for obese patients, since they do not result in weight gain.
- Biguanides ( metformin)
- A- glucosidase inhibitors
- Glitazones
Insulin
For an absolute or relative insulin deficiency, this must be replaced by insulin preparations.
α -glucosidase inhibitors
These substances retard by the inhibition of α -glucosidase uptake of glucose from the intestine into the blood and thus relieve the blood sugar spikes after high-carbohydrate meals.
Approved for Type 2 Diabetes substances are acarbose, miglitol and voglibose.
Sulfonylureas
They stimulate the beta cells of the pancreas to increase the secretion of insulin, causing the blood sugar level is lowered. If there is a significant lack of insulin due to exhaustion of the pancreas (known as secondary failure ), usually an insulin therapy should be started. Known representatives are glibenclamide and glimepiride.
Biguanide
Biguanides inhibit glucose formation ( gluconeogenesis ) in the liver cells. They reduce the absorption of glucose from the intestine and increase their utilization in the periphery, such as in the muscles.
Metformin is the only currently approved drug from the biguanide class.
Glinides
The group of glinides is composed of two chemically heterogeneous substances whose effect lies in a rapid and short-term insulin release.
As repaglinide is a benzoic acid derivative nateglinide is derived from the amino acid phenylalanine.
Repaglinide is approved in the German market since 1999 and nateglinide since 2000.
The glinides be used for the treatment of type 2 diabetes, allowing a greater variability in food intake with reduced risk of hypoglycemia.
Insulin sensitizers ( glitazones )
Glitazones improve the action of insulin by existing synthesis increase of GLUT4 receptors and thereby reduce the insulin resistance in type 2 diabetes.
As the only approved glitazone, pioglitazone should be prescribed since April 2011 only in exceptional cases, at the expense of the statutory health insurance.
Inkretinmimetika and dipeptidyl peptidase - 4 inhibitor
The Inkretinmimetika and inhibitors of dipeptidyl peptidase- 4 act through the incretin effect.
While the incretin mimetics simulate the effects of a natural hormone GLP -1, the inhibitors of dipeptidyl peptidase -4 inhibit its degradation. Lead compound of Inkretinmimetika is the exenatide. Authorised substances are sitagliptin, vildagliptin and saxagliptin.
SGLT -2 inhibitor
SGLT -2 inhibitors promote the excretion of glucose by the kidney, this leads to a lowering of blood sugar.
Amylin analogues
Amylin is normally produced at meals in the beta cells of the pancreas. It inhibits the secretion of glucagon after meals. In diabetics, the dividend is reduced.
Pramlintide ( U.S. trade name: Symlin ) is an analogue of the hormone Amylin and was approved in the U.S. for the treatment of type 1 and type 2 diabetes. Symlin is the first drug that has been approved since insulin for type 1 diabetics.