Oral hypoglycaemic agents

Oral hypoglycaemic agents Oral blood glucoselowering drugs Insulin secretagogues Antihypergly-caemics... 

M. Fujimaki, N. Ishigaki, H. Hakusui, Metabolic Fate of the Oral Hypoglycaemic Agent, Midaglizole, in Rats , Xenobiotica 1989, 19, 609-625. 

Repaglinide is a newer oral hypoglycaemic agent, indicated in type 2 diabetes either in combination with metformin or as monotherapy. Repaglinide stimulates insulin release. 

II.f.2.1. Oral hypoglycaemic agents. There are now five groups of orally active drugs available to lower blood glucose in clinical practice (Table 2). These are sulphonylureas, biguanides, alpha-glucosidase inhibitors, thiazolidinediones, and the incretin derivatives. 

Comparison of repaglinide vs gliclazide in combination with bedtime NPH insulin in patients with type 2 diabetes inadequately controlled with oral hypoglycaemic agents. Diabetic Med 2003 20 935 11. 

Goudswaard AN, Stolk RP, de Zuithoff P, Valk HW, Rutten GE. Starting insulin in type 2 diabetes continue oral hypoglycaemic agents J Fam Pract 2004 53 393-9. 

Bertini AM, Silva JC, Taborda W, Becker F, Bebber FRL, Viesi JMZ, Aquim G, Ribeiro TE. Perinatal outcomes and the use of oral hypoglycaemic agents. J Perinat Med 2005 33 519-23. 

Insulin monotherapy versus combinations of insulin with oral hypoglycaemic agents in patients with type 2 diabetes mellitus. Cochrane Database Syst Rev. 2004 CD003418. 

The natural history of Type-II diabetes mellitus is characterized by a progression of B-cell dysfunction. Many patients are initially well controlled by diet but, as the years go by, they need oral hypoglycaemic agents and eventually insulin for satisfactory glycaemic control. Some 17% of all Type-II diabetics are treated with insulin, and 5% of Type-II diabetics are switched to insulin each year (Marble and Camerini-Davalos, 1961). The point at which a patient should be put on a insulin regimen, however, is not always easy to assess and may be determined by life expectancy, morbidity and compliance of the patient. 

The cornerstone of management of Type-II (NIDDM) diabetics is diet and exercise. The majority of these patients, however, will remain hyperglycaemic and are candidates for oral hypoglycaemic agents. 

There are three conditions for the clinical use of metformin as a glucose-lowering agent in patients with NIDDM (1) as a primary drug, (2) in combination with other oral hypoglycaemic agents such as sulphonylureas and acarbose, and (3) together with insulin after secondary sulphonylurea failure. 

Miscellaneous compounds of pharmacological interest have been shown to inhibit aromatase in vitro, including the antimalarial drug mefloquine, [138], the oral hypoglycaemic agent, tolbutamide [139], and nicotine, its metabolite cotinine, and anabasine, all of which are found in tobacco [140]. These effects probably have little clinical relevance, although the latter three compounds may account for the reduced urinary [141] and plasma [142] oestrogen concentrations found in smokers [140],... 

In the first smaller randomised trial 68 type 2 patients with HbAlc between 8.1 and 11.9% despite treatment with sulfonylurea and/or metformin were randomised to receive inhaled insulin in addition to pre-study OHA (oral hypoglycaemic agents) or to continue to take OHA alone for 12 weeks [58]. After 12 weeks a mean reduction in HbAlc of 2.3% was found in the first group, compared with 0.1% in the group treated with OHA alone [58]. No long-acting insulin was used in the study. 

Insulin Monotherapy versus Combinations of Insulin with Oral Hypoglycaemic Agents in Patients with Type 2 Diabetes... 

Linogliride and pirogliride are oral hypoglycaemic agents which differ in their mechanism of action from the biguanides and sulphonylureas. Both are potent enhancers of glucose-induced insulin secretion [375,376]. 

Rowe BR, Thorpe J, Barnett A. Safety of fluconazole in women taking oral hypoglycaemic agents. Lancet( 992) 339, 255-6. 

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