There are a handful of oral drug therapy options for the management of diabetes. Management of diabetes is aimed at controlling both short-term and long-term complications. Short-term complications are associated with hyperglycemia. Symptoms of this include polyphagia (excessive eating), polydipsia (intense thirst leading to consumption of large quantities of fluid), polyuria (production of large volumes of urine), weight loss, and fatigue. Some long-term complications consist of retinopathy (disorder of the retina leading to impairment of vision), nephropathy (disease of kidney), neuropathy (any disease of the peripheral nerves) and coronary artery disease. Management of these complications can be achieved by maintaining appropriate glucose levels. Lifestyle changes, drug therapy, or a combination of the two can achieve this.

Sulfonylureas such as Glipizide or Glyburide and Meglitinides such as Prandin® work by increasing the release of insulin by stimulation of cells of the pancreas. These medications should be taken 30 minutes prior to a meal. It is important however, if a meal is skipped, that these medications not be taken due to the risk of hypoglycemia (low blood glucose). Weight gain of 4-11 pounds may occur in those taking these medications.

Metformin, which belongs to a class of medications known as Biguanides, works by multiple mechanisms to lower blood glucose. One advantage of this medication is that it's not associated with weight gain and patients may actually loose some weight. An additional advantage is that it may decrease total cholesterol and LDL levels by 5-10% and increase HDL (good cholesterol) by 5%. The most common adverse effects are nausea, vomiting, and diarrhea. These can be minimized by slowly increasing the dose by 500mg intervals weekly and by taking with food. This medication should not be used in those who have renal disease, congestive heart failure (CHF), or chronic alcohol consumption due to the risk of lactic acidosis which may be fatal in this patient population.

Thiazolidinediones such as Avandia® and Actos® are used alone or in combination with other medications such as Metformin. These medications are less likely to cause hypoglycemia. Side effects associated with these medications include nausea, vomiting and abdominal pain. These medications may also cause weight gain. Liver function may also be elevated by this medication, and it is important that liver function be monitored every two months for the first year of treatment.

These medications along with diet and exercise will provide control of high blood glucose, thereby reducing complications associated with diabetes.

Reference: Dipiro JT, et al. Pharmacotherapy, A Pathophysiologic Approach. 5th ed., 2002.

Written by Andrea Trujillo, UNM College of Pharmacy PharmD candidate.

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