How to choose a treatment plan for a diabetic patient needs to be specific to each individual based on the patient’s medical history, medication use, and the presence of any current complications or comorbidities. And each doctor will also choose different drugs according to their own knowledge, experience, and preference, there is no set in stone, it needs to be individualized.
I will give a brief introduction to the mainstream oral medications for type 2 diabetes and some of the newer oral medications, so that we can have an overall understanding. In pre-diabetic or diabetic patients, especially type 2 diabetic patients, on the basis of diet and exercise control, if blood glucose control is still unsatisfactory, it involves the use of drugs. Patients often ask me in the clinic, what is a good medicine, it does not matter if it is more expensive, do I need to use insulin? Is it better to use insulin without side effects? Especially some foreign patients come to Concord from far away to ask if there is a better medicine, and most of the time they come back disappointed. In fact, diabetes is a common disease, and its greatest danger is the silent, continuous progress, treatment methods are similar, the choice of drugs need to be different from person to person. There is no best, only which drug is better for you. With the progress of research, the concept of treatment is constantly updated. Mainly divided into the following categories 1, biguanide drugs: This is the more respected class of drugs, is the first-line drugs recommended by the major guidelines; the main drug is metformin hydrochloride. It mainly inhibits the output of liver glycogen and increases the sensitivity of peripheral tissues to insulin, so it is especially suitable for obese patients. The main side effect is gastrointestinal reaction. 2, sulfonylureas: This class of drugs has also been used for a long time, after the first generation, the second generation, the third generation, the main drugs are glipizide, glimepiride, gliclazide, etc.. It mainly promotes the secretion of insulin, which requires a certain function of pancreatic islet B cells, and if the function of pancreatic islet cells are lost, this drug will have little effect. The main side effect is that it can have led to hypoglycemia and weight gain. 3, thiazolidinediones: This class of drugs is mainly to increase insulin sensitivity, has gone through a tortuous process, from pushing to worry, and then to vindication. Currently the main ones used are pioglitazone hydrochloride (Riton, Ettin, etc.). Its main problem is that it can cause edema and weight gain, and patients with cardiac insufficiency need to be used with caution. 4.Glinide drugs: It mainly promotes insulin secretion, but the site of action is slightly different from sulfonylurea, because it can make insulin secretion quickly and for a short time, so it is mainly used to control postprandial blood sugar, the chance of hypoglycemia is slightly reduced, but it still exists. The main drugs are Repaglinide (Novaluron) nateglinide (Tangli). The main side effects are also hypoglycemia and weight gain. 5, alpha-glucosidase inhibitors: The main action of the enzyme in the intestinal tract, delaying the absorption of glucose in the intestine, so that the postprandial blood glucose rises slowly, reducing blood glucose fluctuations, the drug in the Asian population with the necessary more, mainly related to the diet structure of the Asian population. The main ones are acarbose (Bactrim, Carboplatin), and voglibose (Bexin). The main side effects are abdominal distension and increased exhaustion. 6, dipeptidyl peptidase-IV inhibitor (DPP-IV inhibitor): this drug is relatively new, currently available in China, it mainly acts on intestinal dipeptidyl peptidase, so that the level of GLP-1 is increased, it can promote insulin secretion can also act on the islet A cells, inhibit the secretion of glucagon, is a dual hormone regulation drugs. At present, there are mainly 5 kinds of sitagliptin, viligrastin, etc. 7, sodium – glucose co-transport protein 2 (SGLT2): is a relatively new drug, domestic in the pre-marketing clinical. It mainly inhibits renal glucose reabsorption to achieve hypoglycemic effect. The main drugs currently on the market are Dagliflozin, Dagliflozin, etc. The main side effects of this class of drugs are urinary tract infection and ketoacidosis. The main stream of oral medication is these, some Chinese medicine has a hypoglycemic effect, some of them contain Western medicine ingredients, some are not written, the composition is unclear. We should have a basic concept of what drugs to use still need to see the doctor after the doctor’s decision, do not say what drugs are good for a certain person, I also want to use a certain drug.