Oral Hypoglycemic Agents

Oral antihyperglycemic agents lower glucose levels in the blood. They are commonly used in the treatment of diabetes mellitus.[1, 2]

Biguanides

• Biguanides decrease hepatic glucose production, decrease gastrointestinal glucose absorption, and increase target cell insulin sensitivity

• Example: Metformin[3, 4]

• Contraindications: Metabolic acidosis with or without coma, abnormal creatinine clearance from any cause including diabetic ketoacidosis, shock, acute myocardial infarction, septicemia, renal disease (serum creatinine level ≥1.5 mg/dL in males or ≥1.4 mg/dL in females), lactation, radiologic contrast study within 48 hours

Sulfonylureas

• Sulfonylureas increase beta-cell insulin secretion, decrease hepatic glucose output, and increase insulin receptor sensitivity at peripheral target tissues

• Examples: Glyburide, glipizide, glimepiride, tolazamide, tolbutamide

• Contraindications: Sulfa allergy, type 1 diabetes, diabetic ketoacidosis, concomitant use with bosentan

Thiazolidinediones

• Thiazolidinediones increase insulin receptor sensitivity and influence the production of gene products involved in lipid and glucose metabolism; their mechanism of action depends on the presence of insulin for activity[5]

• Examples: Pioglitazone, rosiglitazone

• Contraindications: Hypersensitivity to product or components, established NYHA class III/IV heart failure

Alpha-glucosidase inhibitors

• Inhibit the upper gastrointestinal enzymes that convert dietary starch and other complex carbohydrates into simple sugars, which can be absorbed
• Examples: Acarbose (Precose) & Miglitol (Glycet)
• Contraindications: Diabetic ketoacidosis; cirrhosis; inflammatory bowel disease, colonic ulceration, partial intestinal obstruction,