I. What kinds of oral hypoglycemic drugs are available? Diabetes develops mainly from insufficient insulin secretion and the body’s poor response to insulin, the latter also known as insulin resistance. Oral hypoglycemic drugs are designed to solve these two problems. Currently approved oral hypoglycemic agents include: 1. Insulin-producing agents Insulin-producing agents stimulate insulin secretion and increase the level of insulin in the body. They are suitable for patients with type 2 diabetes who have relatively high blood sugar but still have the potential insulin secretion ability. (1) Sulfonylureas: methanesulfonylurea (D860), gliphenylurea (euglycemia), gliclazide (Damacell), glipizide (glucophage), glipizide (Mepida) and glimepiride. Among them, glipizide is a good sulfonylurea hypoglycemic drug, which meets all the conditions of a good oral hypoglycemic drug – complete absorption, fast, strong and moderate action, and not much risk of causing hypoglycemia. (2) Glinides: The target is mainly for those who are not fat and have potential insulin secretion ability but have poor effect on sulfonylureas. The representative drugs are: Repaglinide (Novaluron) and Naglinide (Tangli). 2. Non-insulin secreting agents (1) α-glucosidase inhibitors: Delay and reduce the absorption of starch and fructose in the intestine. It is especially suitable for those with high postprandial glucose. Currently used glucosidase inhibitors include acarbose (Bactrim) and voglibose (Bexin) two. (2) Biguanides: Biguanides mainly inhibit hepatic glucose production, and may also have the effect of delaying intestinal absorption of glucose and enhancing insulin sensitivity. For more vigorous appetite, heavy weight people can be the first choice. Representative drugs are metformin. (3) Glitazones: They are insulin sensitizers, which do not stimulate insulin secretion and can enhance the effect of insulin by reducing insulin resistance. Representative drugs are: rosiglitazone and pioglitazone. Second, how to choose oral hypoglycemic drugs? 1.Factors that determine the choice of glucose-lowering drugs: Obesity, especially centripetal obesity, is the main determinant of insulin resistance, and is therefore an important reference for the choice of glucose-lowering drugs. Other factors that determine drug selection include the availability of the drug on the market, side effects, allergic reactions, age and other health conditions such as kidney and liver disease. Because type 2 diabetes is a progressive disease, most patients can experience a decline in therapeutic efficacy after a period of treatment with a single oral hypoglycemic agent. Therefore, two oral hypoglycemic agents with different mechanisms of action are often used in combination therapy. If the combination of oral hypoglycemic drugs still cannot effectively control blood sugar, then “doubling one drug is better than combining two drugs”, and insulin can be used in combination with an oral hypoglycemic drug. Although the combination of three hypoglycemic drugs can further improve blood glucose on the basis of the combination of two drugs, the safety and cost-benefit ratio of this combination treatment method has yet to be evaluated. Patients with severe hyperglycemia should first use insulin to lower blood glucose and reduce the risk of acute complications of diabetes. After the blood glucose is controlled, the treatment plan can be redefined according to the condition. 2. Drug selection and treatment procedures for obese or overweight patients with type 2 diabetes mellitus: If obese or overweight patients with type 2 diabetes mellitus cannot satisfactorily control their blood glucose with diet and exercise, they should first be treated with non-insulin secretagogue hypoglycemic drugs (those with metabolic syndrome or with other cardiovascular disease risk factors should preferably use biguanides or glitazones, and patients who mainly exhibit postprandial hyperglycemia should also (Preference may be given to alpha-glucosidase inhibitors.) Two drugs with different mechanisms of action can be combined with each other. If the blood glucose control is still unsatisfactory, insulin secretagogue can be added or replaced. If blood glucose control is still unsatisfactory despite the use of insulin secretagogues, the combination of insulin or insulin can be started on the basis of oral medication. 3. Drug selection and treatment procedures for type 2 diabetes mellitus patients with normal weight: In the case of non-obese or overweight type 2 diabetes mellitus patients whose blood glucose cannot be satisfactorily controlled by diet and exercise, insulin secretagogue hypoglycemic agents or α-glucosidase inhibitors can be used first. If blood glucose control is still unsatisfactory, non-insulin secretagogue agents can be added (those with metabolic syndrome or with other cardiovascular disease risk factors preferably choose biguanides or glitazones, and α-glucosidase inhibitors are suitable for patients without obvious fasting hyperglycemia but postprandial hyperglycemia). In the case of unsatisfactory glycemic control despite the combination of the above oral drugs, the combination of insulin or switching to insulin can be started on the basis of oral drugs. Oral hypoglycemic drugs should also pay attention to the following points: ① only for type 2 diabetics; ② the same class of hypoglycemic drugs should not be used in combination; ③ sulfonylureas and sulfonamides (such as cotrimoxazole) have cross-allergic reactions, so people who are allergic to sulfonamides should be careful with sulfonylureas hypoglycemic drugs; ④ drug therapy must be combined with diet control and exercise.