About the treatment of diabetes drugs, if you only know sulfonylureas, glinides, biguanides, alpha-glucosidase inhibitors, thiazolidinediones, insulin, then you are behind! The new era of sugar control is here, and this article will give you an inventory of these new drugs.
Glucagon analogues
Glucagon, also known as pancreatic amyloid peptide, is another glucose-lowering hormone secreted by pancreatic islet B cells, and is secreted synergistically with insulin in response to glucose stimulation. Glucagon reduces blood glucose and body weight by decreasing postprandial glucagon secretion, delaying gastric emptying, and suppressing appetite.
Benefits: Significantly reduces glycated hemoglobin levels, decreases body weight, and reduces insulin dosage with no significant effect on fasting glucose.
Adverse effects: The main adverse effects include gastrointestinal reactions, such as nausea, anorexia and vomiting.
Representative drug: The representative drug of insulin analogue is Pramlintide acetate, which has been approved by the U.S. Food and Drug Administration (FDA) for use as an adjunct to insulin therapy in patients with type 1 and type 2 diabetes.
Sodium-glucose co-transporter protein-2
SGLT-2i blocks glucose reabsorption by inhibiting renal proximal tubular sodium-glucose co-transporter protein, resulting in insulin-independent blood glucose reduction and a slight hypotensive effect. SGLT-2i inhibitor is an anti-type 2 diabetes drug based on a novel therapeutic mechanism that shows great potential in the treatment and prevention of type 2 diabetes.
Advantages: wide range of use, especially for improving blood glucose in patients with renal diabetes; less likely to cause hypoglycemia; improves B-cell function and insulin resistance; reduces the potential for water and sodium retention and reduces the risk of cardiovascular-like disease.
Adverse effects: Recently, the FDA suggested that patients with type 1 or type 2 diabetes should be alerted to the risk of ketoacidosis with SGLT-2i. symptoms of ketoacidosis include nausea, vomiting, abdominal pain, fatigue, and dyspnea. patients with these symptoms should discontinue SGLT-2i and seek immediate medical attention. SGLT-2i can also cause urinary tract infections, leading to urinary sepsis and pyelonephritis.
Representative drugs: SGLT-2i class drugs marketed in Europe and the United States in recent years include Empagliflozin (EU EMA, 2014), Dapagliflozin (US FDA 2014 approval) and Canagliflozin (US FDA 2013 approval).
Enterostatin-related drugs
Glucagon is a gut-derived hormone in the human body that promotes insulin secretion and exerts glucose-concentration-dependent hypoglycemic effects after food intake, and glucagon-like peptide-1 (GLP-1) is a very important member of this hormone.
Advantages: Glucagon secretion is glucose-dependent, thus avoiding the adverse effects of hypoglycemia that often exist in traditional diabetes drug therapy; secondly, it can protect pancreatic islet B cells, stimulate their proliferation and differentiation, and treat diabetes from the root.
Disadvantages: These drugs can only assist in blood glucose control and are not recommended for first-line treatment; they should be used with caution in patients with a history of pancreatitis; they should not be used in the treatment of acute complications such as type 1 diabetes and ketoacidosis.
Adverse reactions: mainly nausea, diarrhea, vomiting and other common reactions.
Representative drugs: Exenatide, Liraglutide, and the recently released Albiglutide.
Dipeptidyl peptidase-4 (DPP-4)
DPP-4 inhibitors protect glucagon-like peptide-1 (GLP-1) from degradation and thus play a role in the treatment of type 2 diabetes.
Advantages: These drugs are small molecule compounds that are effective when taken orally, eliminating the need for painful subcutaneous injections, and DPP-4 inhibitors significantly lower serum cholesterol, reducing the risk of cardiovascular disease.
Disadvantages: Patients are prone to upper respiratory tract infections, headaches, nasopharyngitis and other common adverse effects caused by oral hypoglycemic agents.
Representative drugs: The most studied and clinically used DPP-4 inhibitors are sitagliptin, vildagliptin, saxagliptin, alogliptin and linagliptin.
Some of the new glucose control drugs are currently available only in foreign countries, such as the SGLT-2i class of drugs. We are looking forward to more new glucose control drugs coming to market in China and entering medical insurance, so that more sugar lovers can benefit from them.