DIABETES MELLITUS-NEWER AGENTS

SUMMARY

1. Amylin analogs: suppresses glucagon & slows stomach emptying.

2. GLP1 agonists: incretin hormones are secreted by the gut & regulate glucose by stimulating insulin release, inhibiting post-prandial glucagon release, slowing nutrient absorption, and accelerating satiety. E.g. Semaglutide. Add-on drugs.

3. DPP4 inhibitors: decrease the inactivation of incretins. Biggest effect on decreasing post-prandial glucose. Sitagliptin is an example. SE: pancreatitis, URTI, hypoglycemia (less likely). Add-on drugs.

4. SGLT-2 inhibitor: block the co-transport of sodium & glucose in the proximal tubule. These drugs do not cause hypoglycemia, and they lead to modest weight loss. E.g.Empagliflozin. SE: dehydration, AKI, UTI, genital mycotic infections.

Reference(s)

Wilkinson, I., Furmedge, D. and Sinharay, R. (2017). Oxford handbook of clinical medicine. Oxford: Oxford University Press. Get it on Amazon.
Feather, A., Randall, D. and Waterhouse, M. (2020). Kumar And Clark’s Clinical Medicine. 10th ed. S.L.: Elsevier Health Sciences. Get it on Amazon.
Hannaman, R. A., Bullock, L., Hatchell, C. A., & Yoffe, M. (2016). Internal medicine review core curriculum, 2017-2018. CO Springs, CO: MedStudy.
Therapeutic Guidelines. Melbourne: Therapeutic Guidelines Limited. https://www.tg.org.au [Accessed 2021].