Met 1: Oral diabetes drugs Flashcards
What is first-line treatment for T2D?
What is second-line?
- Lifestyle changes
- (low calorie diet with complex carbs and lean protein, physical activity)
- Metformin
What is Metformin’s MOA?
- Inhibits complex-1 in Electron Transport Chain
- think “No spark in the Sketchy valentine relationship”
- This prevents hepatic glucose release
*It does NOT affect insulin release
ADR of metformin (2)
Price?
Weight status?
Hypoglycemia common?
Metformin
ADR: lactic acidosis (esp if renal dz), N/V
Cheap
Weight neutral
No hypoglycemia
Describe the normal incretin effect
When glucose is given orally (as opposed to IV), there is an increased insulin response b/c intestinal cells secrete GLP-1
GLP-1 suppresses glucagon and potentiates insulin release
What happens to the incretin effect in T2D patients?
Lessens
Exenatide, liraglutide, dulaglutide
MOA?
GLP-1 Agonists
ADR of GLP-1 agonists (1)
Route
Weight status
Price
Hypoglycemia risk
ADR: N/V
Injection
Causes weight loss
Expensive
Low hypoglycemia risk b/c glucose-dependent activity
Sitagliptin, Saxagliptin
MOA?
DPP-4 inhibitor
(prevent degradation of GLP-1)
Sitagliptin:
Route
Weight
Hypoglycemia risk
Sitagliptin is…
oral
weight-neutral
low risk of hypoglycemia
Compare sitagliptin and liraglutide
Sitagliptin is a DPP-4 inhibitor
Liraglutide is a GLP-1 agonist (MORE POTENT)
Canagliflozin, dapagliflozin
MOA
SGLT-2 inhibitors
Block reuptake of glucose in kidney
ADR of Canagliflozin, dapagliflozin (3)
ADR: Fournier’s Gangrene, GU infections, euglycemic ketoacidosis
Canagliflozin, dapagliflozin
Weight status
Hypoglycemia risk
Route
Canagliflozin, dapagliflozin
Weight loss
No hypoglycemia
oral
Sulfonylurea MOA
Close the ATP-sensitive K+ channel in beta cells, causing insulin release (regardless of glucose)
*This requires having some functional beta cells
Sulfonylurea ADR (2)
Sulfonylurea ADR
- Hypoglycemia
- Weight gain
