ENDOCRINE KEY POINTS 7

ANTIDIABETIC DRUGS
GROUPS ACTION ADVANTAGES DISADVANTAGES CONTRAINDICATIONS PREPARATIONS SIDE EFFECTS
- T1DM - DKA & HHNS 1st generation
- ↓ Hb A1C by 1 -2 % potent. - ↓ Efficacy over time. - T2DM é hypoglycemia Hypoglycemia, Weight gain,
- Few side effects except..... - Hypoglycemia. - DM in pregnancy Chlorpropamide ↑ Risk CVS diseases,
SU K+ channel closer. - Experience many years. - Weight gain. - Surgery 2nd generation Blood: Anemia (Hemolytic,
- Not expensive. - ↑ Risk CVS diseases. - Stressful situations Glimerpiride, Aplastic),
- ↓Ischemic - Severe liver or renal disease Glibenclamide, GIT: upset
preconditioning - Hypersensitivity Gliclazide,
Glyburide
- Less effective than SU. Same as SU +
Glinides +
K channel closer. - Minimal risk of hypoglycemia. - ↓ Hb A1C by 0.7 -1.5 %. Co-administration of Repaglinide, Hypoglycemia, Weight gain
- Flexible dosages (No meal no tab). - Need multiple doses . gemfibrozil é Repaglinide →↑ Neteglinide
- More expensive than SU. Hypoglycemia
Insulin sensitizer, - ↓ Hb A1C by 1 -2 % potent.
↓IR, ↓Hepatic - No Hypoglycemia. Same as SU + Vit. B12 MA,
Biguanides gluconeogenesis, - Experience many years. - ↓ Efficacy over time. GFR < 30ml/min Metformin rarely anemia or homocysteinemia
↑Peripheral - Not expensive. - GIT upset, Lactic acidosis. Metabolic acidosis GIT upset, Lactic acidosis
glucose uptake - ↓weight, LDL & TG.
- no CV risk, 1st line of ttt.
Insulin sensitizer, - ↓ Hb A1C by 0.5-1.5 % potent. - ↓ Efficacy over time. Pioglitazone Hypoglycemia, Weight gain,
TZDs ↓IR, - ↓TG, ↑HDL esp. é Pioglitazone - ↓bone density, ↑risk HF. Same as SU + HF, Osteoprosis Roziglitazone ↑ Risk CVS diseases, HF,
PPARγ agonists Minimal risk of Hypoglycemia. (Withdrawn) Osteoprosis, Bladder cancer
Inhibit Nasopharyngitis, Headache, N,
degradation of - Well tolerated é few side effects. - ↓ Hb A1C by 0.5 -1 %. Sitagliptin, Hypersensitivity, SKin reaction, ↑risk
DPP4 - I incretins - Minimal risk of hypoglycemia Modest Same as SU Vildagliptin, é pancreatitis & Pancreatic cancer
"Incretin & weight gain. Saxagliptin (Sitagliptin)
enhancer"

- ↓ Hb A1C by 0.8 -1.8% Same as SU + Gastroparesis, N, V, ↑risk é pancreatitis &

GLP1 Incretin mimetics - Minimal risk of hypoglycemia, - GIT upset, N, V, Liraglutide Exenatide Pancreatic cancer,
agonists weight loss, Expensive. (CI/FH of MEN2) Liraglutide Hypoglycemia if taken é SU,
- ↓ ASCVD risk (é Liraglutide) Injectable Renal impairment
↓α Amylase & α - Controls PP hyperglycemia. - ↓ Hb A1C by 0.5 -1 %. Same as SU + GIT: Flatulence, Abdominal
AGIs glucosidase - No hypoglycemia. Modest GIT proplems (IBD, MAS) Acarbose distension, Diarrhea
enzymew - No weight gain. - GIT Problems.

Amylin Amylin mimetics - Controls PP hyperglycemia. - ↓ Hb A1C by 0.5 -1 %. Hypersensitivity, Pramilintide N, V, Hypoglycemia, Injection - site
mimetics T1DM, T2DM - weight loss. Injectable Gastroparesis reaction
Blocks SGLT2 - Minimal risk of hypoglycemia, ↓BP. - ↓ Hb A1C by 0.5 -1 %. Same as SU + Marked renal Dapagliflozin
SGLT2 - I receptor in kidney - weight loss, ↓TG, ↑HDL, ↓ ASCVD risk. - Not effective in impairment eGFR < 30 ml/min Canagliflozin UTI, Genital infection, ↑K
GFR < 45ml/min, Empagliflozin
↑LDL,UTI.

7
ENDOCRINE KEY POINTS 7
Insulin: indications: CI of SU + T1DM + ↑K Dose: Start é 20 units/day & ↑by 5-10 units/day Administration: Single, Twice, Multiple, Insulin pump, IVI, IM, Insulin spray
Preparations: Short acting [Analogues - Lipspro, Aspart, Glulisine -, Regular], Intermediate NPH, Long acting [Glargine, Determir], Mix [NPH/Regular 70/30]
Complications: Hypoglycemia, Weight gain, Insulin lipodystrophy, Allergic reactions, IR, Dawn phenomenon, Somogyi effect