To evaluate the advantages and disadvantages of a glucose-lowering drug, it is necessary to measure comprehensively, not only the glucose-lowering effect, but also safety, tolerability, compliance, price factor and whether it has cardiovascular protection, etc.
1, the advantages and disadvantages of sulfonylureas
Sulfonylurea hypoglycemic drugs are the earliest and most widely used oral hypoglycemic drugs, mainly by stimulating the pancreatic islets to secrete insulin and increase the level of insulin in the body to lower blood sugar. They are commonly used in clinical practice, such as Glucophage, Damacell, Euglycemia, Mepida and Amoril.
Advantages: outstanding efficacy, inexpensive, first-line drugs for type 2 diabetes, no adverse cardiovascular effects, no cancer risk.
Disadvantages: prone to hypoglycemia and weight gain, individual patients may experience skin allergic reactions, leukopenia, etc. Secondary failure can occur during use. For the elderly and mild to moderate renal insufficiency, it is recommended to take short-acting, biliary excretion of sulfonylureas, and glyburide is more suitable.
2.The advantages and disadvantages of glargine class
It belongs to the new generation of insulin secretagogues, with Novaluron and Tangli as representative drugs, and can be used in combination with other types of oral hypoglycemic drugs and basal insulin.
Advantages: Simulating insulin secretion at mealtime, it can effectively reduce postprandial hyperglycemia and is less prone to hypoglycemia, has little effect on body weight, and can still be used by patients with mild to moderate renal insufficiency. It is convenient and flexible to be taken at mealtime, and the patient’s compliance is good, which is more suitable for those who have irregular meals or elderly patients. When sulfonylureas fail, the use of glinides can still be effective.
Disadvantages: the price is higher, improper use can also cause hypoglycemia.
3.The advantages and disadvantages of metformin
Metformin mainly lowers blood sugar by reducing insulin resistance, promoting glucose utilization by peripheral tissues and inhibiting hepatic glucose output. It is currently the first-line preferred hypoglycemic agent for the treatment of diabetes, and can be used either alone or as a base drug for various combination therapy programs (such as insulin combined with oral hypoglycemic agents).
Benefits: In addition to effective glucose-lowering, metformin can also reduce body weight, blood pressure and blood lipids, has cardiovascular protective effects, significantly improves long-term prognosis, and is the first choice for overweight or obese diabetic patients. It is safe, does not cause hypoglycemia when applied alone, and is less likely to cause lactic acidosis compared to hypoglycemia. Cheap and cost-effective.
Disadvantages: Gastrointestinal reactions are common, and long-term application may affect the absorption of vitamin B12. Contraindicated in patients with heart failure, hypoxia and severe liver and kidney insufficiency to avoid lactic acidosis.
4.The advantages and disadvantages of α-glucosidase inhibitors
Mainly through delaying the absorption of carbohydrates to lower blood sugar (especially postprandial blood sugar), it is suitable for Chinese patients who mainly eat carbohydrates, and can be used in combination with diet, exercise and other hypoglycemic drugs. The representative drugs are Bactrim, Carboplatin and Bexin, which are chewed with the first bite of main food at mealtime.
Advantages: the effect of hypoglycemia is sure, mainly in the intestinal tract, only 2% is absorbed into the blood, the liver and kidney and other systemic side effects are few, no weight gain or weight loss, the drug alone does not cause hypoglycemia, has a protective effect on cardiovascular, suitable for elderly diabetics and patients with renal impairment, and is also the only hypoglycemic drug with indications for IGT treatment at home and abroad.
Disadvantages: Some patients have gastrointestinal reactions such as abdominal distension and increased exhaustion when first used, and it is prohibited for people with gastrointestinal disorders, pregnant women, lactating women and children. Note that the combination with other hypoglycemic drugs can cause hypoglycemia, and once it occurs, it should be corrected with glucose, and eating starchy food is not effective.
5.The advantages and disadvantages of insulin sensitizers
The representative drugs are rosiglitazone (Vindia, Tylenol) and pioglitazone (Icotox).
Advantages: It does not stimulate insulin secretion, but exerts glucose-lowering effects by enhancing the sensitivity of tissues to insulin. These drugs are suitable for type 2 diabetes, reduced glucose tolerance and with metabolic syndrome. They can be combined with biguanides, sulfonylureas or insulin to further improve glycemic control. It does not cause hypoglycemia when used alone.
Disadvantages: slow onset of action, can lead to water and sodium retention, cause edema and slight weight gain, increase the risk of heart failure, cardiac function grade 3 or above is prohibited. Patients with bladder cancer, patients with a history of bladder cancer should avoid the use of pioglitazone.
6.The advantages and disadvantages of DPP-4 inhibitors
It is a new type of glucose-lowering drug based on the mechanism of enteroglucagon (GLP-1), currently marketed in China, such as sitagliptin (Genovent), saxagliptin (Anritzer), vildagliptin (Gavril), etc.
Advantages: It increases endogenous GLP-1 level and improves pancreatic α and β cell dysfunction, with the advantages of precise glucose-lowering efficacy, low risk of hypoglycemia, no weight gain, no gastrointestinal reactions, and high safety and tolerability. It only needs to be administered once a day, and patients have good compliance.
Disadvantages: There are side effects such as headache, nasopharyngitis, cough, constipation, dizziness and increased sweating, but the incidence is very low. The disadvantage is that it is more expensive and not yet covered by medical insurance in China.
7.The advantages and disadvantages of SGLT-2 inhibitors
The mechanism of action of these drugs is different from that of traditional hypoglycemic drugs, mainly by inhibiting SGLT-2 activity, reducing renal reabsorption of glucose and increasing urinary glucose excretion, thus lowering blood sugar. At present, the foreign marketed ones are Dagliflozin.
Advantages: SGLT-2 inhibitors are rarely associated with hypoglycemia and have beneficial effects on improving body weight and blood pressure. Good compliance with oral tablets, taken once a day.
Disadvantages: May be associated with nasopharyngitis, fungal infections, and genitourinary infections, and the safety of long-term use needs to be further observed.
8.The advantages and disadvantages of GLP-1 receptor agonists
At present, the GLP-1 agonists listed in China are exenatide (Bactrim) and liraglutide (Novalax).
Advantages: In addition to significantly lowering blood glucose, they can also reduce body weight, lower blood pressure and improve β-cell function, showing the potential to delay the progression of diabetes and reduce cardiovascular complications of diabetes, which is a combination of multiple pharmacological effects that existing diabetes treatment drugs do not have. It has a low risk of hypoglycemia due to its glucose concentration-dependent hypoglycemic mechanism that is consistent with physiological requirements.
Disadvantages: Gastrointestinal adverse effects such as nausea and vomiting. The clinical application is short, expensive and requires injectable medication, which is not recommended as the first-line medication.
9.The advantages and disadvantages of insulin and its analogues
Clinically used insulins and insulin analogues are: Novolin R, Novolin 30R, Novolin N, Novalax, Novalax and so on.
Advantages: insulin and insulin analogues are by far the most powerful weapons to control blood sugar, with no adverse effects on liver and kidney. All diabetic patients who are not suitable for oral hypoglycemic drugs (such as type 1 diabetes, pregnant women, diabetic ketoacidosis, patients with liver and kidney insufficiency, etc.) can switch to insulin therapy. Early use of insulin can also help protect and repair the function of pancreatic beta cells.
Disadvantages: relatively high risk of hypoglycemia, weight gain, skin allergy or fat atrophy at the injection site of individual patients, inconvenience to patients from injection, high price of insulin analogues.
10.The advantages and disadvantages of the Chinese patent medicine for lowering sugar
Advantages: Although the hypoglycemic effect is weak, there is no risk of hypoglycemia and no weight gain; it can improve symptoms, assist in regulating lipids and lowering blood pressure, and prevent chronic complications by “nourishing Yin, invigorating blood and tonifying kidney”; it can be combined with various oral hypoglycemic drugs or insulin.
Disadvantages: the effect of lowering sugar is not good, only as an auxiliary treatment, not very convenient to take.