For
decades, clinicians relied on a limited number of drugs, including
sulfonylureas and metformin, to help patients with type 2 diabetes.
However, in the past 20 years, an increasing number of glucose-lowering
drugs for diabetes treatment have become available.
The options come from 4 classes of drugs—dipeptidyl peptidase-4
inhibitors (DPP4I), sodium glucose cotransporter-2 inhibitors (SGLT2I),
glucagon-like peptide-1 receptor agonists (GLP1RA), and pramlintide—that
offer the advantage of employing new mechanisms of action.
The FDA has approved more than 20 new drugs from these classes, and
including fixed-dose combination products significantly increases that
number. This creates a challenge when educating patients about their
diabetes and drug regimens due to the sheer amount of names and
different mechanisms.
An article in the Journal of the Pakistani Medical Association
presents a simple organizational schema that can help pharmacists teach
others—patients, students, and other professionals—how these drugs act.
Available free of charge, the article provides a chart that divides drugs into 3 groups:
· Insulin secretagogues, direct (sulfonylureas and meglitinides) and indirect in nature (GLP1RA and DPP4i)
· Insulin sensitizers, direct (metformin and pioglitazone) and indirect in nature (pramlintide and bromocriptine)
· Nutrient-load reducers, absorption inhibitors (alpha-glucosidase
inhibitors, colesevelam and orlistat) and excretion enhancers (SGLT2i)
Understanding that these medications work in different ways can help
clinicians and patients accept the use of more than 1 drug to address an
elevated glycated hemoglobin (A1C) level and encourage rational drug
use by suggesting how clinicians can prescribe synergistic combinations
based on mode of action. The chart classifies drugs to help clarify
whether they have similar clinical effects based on their mechanisms.
Although most drugs in these classes are pleiotropic (act on multiple
systems) and have multiple mechanisms of action, the author uses the
primary mode of action to place the drug class in its designated square.
The user-friendly table will be a welcome addition to counseling
materials, and pharmacists can use it as the basis for a more
comprehensive tool that includes drug names.
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