Oral Anti-Diabetic Agents

ORAL ANTI-DIABETIC AGENTS (ODA)

What is an oral anti-diabetic agent?

Oral anti-diabetic agents (ODA) are a class of recommended medication used to control diabetes. Oral means ‘taken through the mouth’. Usually, it is designed to help in controlling blood sugar in diabetes type 2 as in diabetes type 1 and gestational diabetes, the treatment always by using insulin injection. 

Classification of oral anti-diabetic agents.

There are five classes of oral anti-diabetic agents (table 1):

• Sulfonylureas. It become a backbone in diabetes treatment since early 1950s. The first generation quickly fell out of favor due to increase in mortality secondary to cardiovascular event and supported by the study of the University Group Diabetes Program (UGDP). The second generation becomes more favorable side effect profiles and contribute to their popularities
• Meglitinides. A new non-sulfonylurea insulin secretagogue agent. The time of onset of action is quicker than sulfonylureas and duration of action is shorter.
• Biguanides. It needs insulin to work, do not stimulate insulin release and not primarily insulin resistance lowering agents.
• Thiazolidinadiones(TZDs).In March 2000, the U.S. Food and Drug Administration(FDA) asked the manufacturer (Parke-Davis, Warner-Lambert) of troglitazone, the first agent in this class to receive labeling approval, to remove the product from the market due to 60 reports of severe liver toxicity.
• Alpha glucosidase inhibitor. 

Mechanism of Action

Mechanism of action means that how the agents react in order to control the glucose level in diabetic patients. It is classified based on the primary site of action of the drug. There are three major categories of the drug action:

      Insulin secretagogues (the agents directly stimulate insulin secretion from the cell of pancreas)

      Insulin sensitizer (the agents that help to reduce the insulin resistance to the body cells)

     An inhibitor of intestinal carbohydrate metabolism (the agents used to delay the absorption of carbohydrate from the intestinal) 

      

      The table below shows the classification of the drug based on their primary site of action. 

Monotherapy and Combination Therapy

Table 2 below show the possible options in the uses of the five classes of Oral Atidiabetic Agents based on the target population.Monotherapy is the uses of single agents in a treatment.

However, if adequate control is not obtained with theuse of a single agent (monotherapy), combination therapy is an option. Several of the availableoral agents have been studied in combinationand have been shown to further improveglycemic control when compared to monotherapy.As with monotherapy, the choice ofa second agent should be based on individualcharacteristics. Reasonable combinations ofagents are shown in Figure 2.

The table below shows the typical doses, side effects and precautions need in a usage of oral anti-diabetic drugs. 

 

 

Adapted from © 2006 The Diabetes Center, Old Saybrook, CT. 

For more explanation, you may look at the video below. 

sources: medical Nutrition Therapy Guideline for Type 2 Diabetes