Antidiabetic drugs biguanides

Biguanides This class of antidiabetics may cause acute poisoning with adverse effects such as acidosis and may be treated by supportive therapy. These drugs have therapeutic interactions with other antidiabetic drugs, alcohol, drugs that affect kidney function, and cimetidine. 

Oral antidiabetes drugs are of two kinds sulphon-amide derivatives (sulphonylureas) and guanidine derivatives (biguanides). They are used by 30% of all diabetics. Unlike insulin they are not essential for life. 

Fig. 2. Use of insulins (black), sulphonylureas (white) and biguanides (grey) as proportions of the total use of antidiabetics drugs in ten European countries (2003). Regional variation is substantial. Reproduced with permission from [11].

A study of the substitution of fenfluramine (initially 40 mg daily, increased to 120 mg daily) for a biguanide antidiabetic found that diabetes was equally well controlled by either drug in 4 of 6 patients. The blood glucose-lowering effects of fenfluramine have also been described elsewhere." It seems that fenfluramine increases the uptake of glucose into skeletal muscle, thereby lowering blood glucose levels. "... 

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