Antidiabetic Drugs Nursing Considerations & Management

Notes

Antidiabetic drugs are a group of drug structurally unrelated to sulfonylureas and are effective when used in combination with insulin or sulfonylureas. These drugs include alpha-glucosidase inhibitors, biguanides, dipeptidyl peptidase-4 (DPP-4) inhibitors, human amylin, incretin mimetics, meglitinides, and thiazolidinediones.


Table of Common Drugs and Generic Names

Here is a table of commonly encountered other antidiabetic agents, their generic names, and brand names:

Classifications Generic Name Brand Name
Alpha-glucosidase inhibitors acarbose miglitol Precose, Glyset
miglitol Glyset
Biguanide metformin Glucophage
Dipeptidyl peptidase-4-inhibitors linagliptin Tradjenta
saxagliptin Onglyza
sitagliptin Januvia
Human amylin pramlintide acetate Symlin
Incretin mimetics exenatide Baraclude
liraglutide Victoza
Meglitinides nateglinide Starlix
repaglinide Prandin
Thiazolidinediones pioglitazone Actos
rosiglitazone Avandia

Therapeutic Action

The desired and beneficial action of other antidiabetic agents:

  • Alpha-glucosidase inhibitors acarbose and miglitol inhibit alpha-glucosidase, an enzyme that breaks down glucose for absorption. Therefore, they delay the absorption of glucose. They have only a mild effect on glucose levels and do not enhance insulin secretion. They are associated with severe hepatic toxicity and GI distress.
  • Biguanide metformin decrease the production and increases the uptake of glucose. It is effective in lowering blood glucose and does not cause hypoglycemia as the sulfonylureas do. It has been associated with development of lactic acidosis and GI distress.
  • Meglitinides nateglinide and repaglinide are newer agents that act like sulfonylureas to increase insulin release.
  • Synthetic human amylin pramlintide works to modulate gastric emptying after a meal to cause a feeling of fullness or satiety. It also prevents the postmeal rise in glucagonthat usually elevates glucose levels. Human amylin is a hormone produced by beta cells in the pancreas that is important in regulating postmeal glucose levels. It should not be used when patient is unable to eat.
  • Incretin mimetics exenatide and liraglutide mimic the effects of GLP-1: enhancement of glucose-dependent insulin secretion by the beta cells in the pancreas, depression of elevated glucagon secretion, and slowed gastric emptying to help moderate and lower blood glucose levels.
  • DPP-4 inhibitors lina-, saxa-, and sitagliptin slow the breakdown of GLP-1 to prolong the effects of increased insulin secretion, decreased glucagon secretion, and slowed GI emptying.
  • Thiazolidinediones pioglitazone and rosiglitazone decrease insulin resistance.

Indications

Other antidiabetic agents are indicated for the following medical conditions:

  • Biguanide metformin is approved for use in children 10 years of age and older. It is also being used in the treatment of women with polycystic ovarian syndrome (PCOS).
  • Meglitinides nateglinide and repaglinide are used to lower postprandial glucose levels because they are rapid-acting and with a very short half-life. They are taken just before meals.
  • Thiazolidinediones pioglitazone and rosiglitazone are used in combination with insulin, metformin, and sulfonylureas in patients with insulin resistance.
  • Bromocriptine, a dopamine agonist used to treat Parkinson’s disease was approved in 2009 as a CNS approach to treat type 2 diabetes.

Pharmacokinetics

Here are the characteristic interactions of other antidiabetic agents and the body in terms of absorption, distribution, metabolism, and excretion:

Route Onset Peak Duration
Oral Slow 2-2.5 h 10-16 h
T1/2: 6.2 h and then 17 h
Metabolism: liver
Excretion: urine

Contraindications and Cautions

The following are contraindications and cautions for the use of agents to control blood glucose level:

  • Allergy to sulfonylureas and other antidiabetic agents. Avoid hypersensitivity reactions
  • Type 1 diabetes. These patients do not have functioning beta cells and would have no benefit from the drug.
  • Pregnancy and lactation. Potential adverse effect on the fetus or neonate.

Adverse Effects

Use of other antidiabetic agents may result to these adverse effects:

  • Common adverse effects include hypoglycemia, lactic acidosis, GI upset, nausea, anorexia, diarrhea, heartburn, and allergic skin reaction.
  • Pioglitazone is strongly linked with an increased risk of bladder cancer if it is used for over 1 year.
  • Rosiglitazone is linked with increased risk of cardiovascular problems.

Interactions

The following are drug-drug interactions involved in the use of other antidiabetic agents:

  • decreased excretion with drugs that acidify urine

Nursing Considerations

Nursing considerations are the same with sulfonylureas.

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