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By Michael Glenn, R.Ph. CGP
Gayco Healthcare Consultant Pharmacist

Diabetes is one of the most common diseases in the world and a constant issue in our facilities.    Diabetes is a metabolic disease involving inappropriately elevated glucose levels due to defective insulin secretions or an inadequate response to the effects of insulin in decreasing glucose levels.   Continuous high glucose levels can result in neuropathy, retinopathy, cardiovascular disease, and renal disease among others.

Most individuals with mild to moderate diabetes can manage the condition with non-insulin medications along with lifestyle and dietary changes. There are several types of these medications with different mechanisms of action to help combat this disease.

Sulfonylureas (Glipizide, Glyburide) are an older class that works by increasing insulin secretions from the pancreas.   Hypoglycemia is a common side effect. Use has decreased due to newer more efficient drugs with fewer side effects.

Metformin is in the class of Biguanides.   This is usually first-line therapy for people with type 2 diabetes.  Metformin decreases glucose release from the liver and decreases intestinal absorption of glucose.  It also increases glucose uptake and utilization.  The most common side effects are nausea and diarrhea.

Thiazolidinediones, TZDs (Actos, Pioglitazone, Avandia) decrease insulin resistance in muscle and fat tissues.  Fluid retention and weight gain are common side effects.

GLP-2 Analogs (Byetta, Victoza, Trulicity) are a rather new class of medications that work by increasing insulin secretions and reducing glucose release from the liver after meals. The most common side effects are nausea and diarrhea. Trulicity can be of benefit since it is injected once weekly.

DPP-4inhibitors (Januvia, Onglyza, Tradjenta) increase insulin secretions and can reduce glucose release from the liver after a meal.     The most common side effects are headaches and upper respiratory infections.

SGLT2 inhibitors (Invokana, Farxiga, Jardiance) are also a rather new class.  They work by increasing glucose excretion in the urine.  These are often prescribed in combination with Metformin. The most common side effects are increased urination and lowered blood pressure.

Success is usually seen with the use of non-insulin medications, often in combination, in people with type 2 diabetes.  The use of insulin should only be used when all other therapies have failed to control blood glucose levels