CLINICAL REVIEW ARTICLES IN PHYSIO PHARMACOLOGY

Book excerpt: Diabetes mellitus (DM) is a chronic metabolic disorder manifested by an enhanced blood glucose levels. DM is categorized into type 1 diabetes and Type 2 diabetes. Metformin is an anti-diabetic medication that is related to the biguanide class. Metformin is the first treatment for Type 2 DM because of its efficacy, safety and minimal risk of hypoglycemia. Sulfonyl ureas namely glipizide and glyburide activate insulin secretion from pancreatic beta cells. Meglitinides, like nateglinide and repaglinide also activate insulin secretion, but their action is short - lived compare to sulfonyl ureas. Thiazolidine diones (TZDs) along with pioglitazone and rosiglitazone activate insulin sensitivity particularly in peripheral tissues. They stimulate peroxisome proliferator - activated receptor gamma (PPAR - gamma ) and give rise to an improved glucose utilization and decreased insulin resistance. Dipeptidyl peptidase - 4 (DPP - 4) inhibitors namely saxa gliptin and sita gliptin continue the action of incretin hormones. Inretin activate insulin release and stop glucagon secretion and contribute to glucose control. Sodium - glucose c0-transporter - 2 (SGLT 2) inhibitors along with canagliflozin and dapagliflozin influence kidneys to decrease glucose reabsorption. Alpha-glucosidase inhibitors namely acarbose, decrease digestion and absorption of carbohydrates in the intestine. Finally it is concluded that the management of diabetes is associated with multifaceted approach, often combining lifestyle modifications and pharmacotherapy.