Oral Anti-diabetic Drugs

Oral Anti-diabetic Drugs Chua Mei Yi Several factors that need consideration when comparing two oral anti-diabetic drugs include degree of glycemic lowering needed to attain target goal range, effect of the medication on weight and lipid profiles, contraindications, side effects, cost, and potential level of adherence to the regimen. The two drugs for comparison are namely metformin and gliclazide. Besides having the same level of glycemic lowering percentage, both metformin and gliclazide are also considered one of the least expensive oral anti-hyperglycemic agents (Reinhold Earl, 2014; Mozaffari, 2013; Holt, Cockram, Flyvbjerg Goldstein, 2011). One of the potential problems with anti-diabetic medication, is that the conventional dosage form is given in 2 to 3 doses daily, and it causes a conflict in compliance rate for the elderly who has poor memories. In this circumstance, both metformin and gliclazide offers the option of single daily dose with either extended-release metformin or gliclazide modified release tablets. Of course the side effects, improvements and degree of glycemic lowering are the same as conventional tablets (Unger, 2013; Barnett, 2012). Metformin is well known for being the first line drug against diabetes type II treatment over the past decades for some reasons. First, Metformin as a biguanide, acts on pancreas independently, inhibiting the liver’s production of glucose, thus controlling blood glucose by improving insulin sensitivity and reducing insulin requirement. If it’s taken when blood glucose is normal or low, it does not stimulate insulin release in the pancreas, thus poses little threat of hypoglycemic (Lehne, 2013). Second, Metformin treatment results in a moderate reduction in circulating triglyceride levels, causing an improvement in lipid profiles that leads to the occurrence of weight loss (Goldstein Muller-Wieland, 2013). Third, having a high frequency of GI side effects due to the inhibition of carbohydrates being digested can be minimized by slow-dose titration and by taking the medication with food. No matter how safe a medication is, contraindications and adverse side effects still need to be observed. As for metformin, renal or hepatic dysfunction patients are contraindicated, and lactic acidosis due to metformin’s accumulation, is considered one of the rare but fatal adverse side effect. The only down side of metformin is, it should be withhold prior to radiological procedures involving contrast dye, as it predisposes patients to acute renal impairment (Reinhold Earl, 2014). Gliclazide, on the other hand, is classified as sulfonylureas. It works by increasing insulin release from pancreatic beta cells, driving blood glucose levels down, causing hypoglycemia if taken when blood glucose is normal or low, thus should only be prescribed to patients likely to have regular food intake. Driving or operating machinery during the initial treatment phase needs to be careful as hypoglycemia might occur (Lehne, 2013). Besides having minimal effect on lipid profile, Gliclazide causes undesirable weight gain due to increased insulin secretion and reduced glucose excretion (Meeking, 2011). Contraindications, particularly renal or liver disease patients, as well as rare but fatal adverse side effects of gliclazide, impairment of liver function, must still be observed (MIMS Australia, 2014). In conclusion, while there is significant debate regarding specific treatment for patients with type II diabetes, most experts agreed upon metformin’s usage as first line drug, judging from its effectiveness, generally well-tolerated cost effective and long term usage. References Barnett, A. (2012). Oxford diabetes library: Type 2 diabetes (2nd ed.). UK: Oxford University Press. Goldstein, B. J., Muller-Wieland, D. (2013). Type 2 diabetes: Principles and practice (2nd ed.). USA: Informa Healthcare. Holt, R. I. G., Cockram, C., Flyvbjerg, A., Goldstein, B.J. (2011). Textbook of diabetes (4th ed.). UK: Wiley-Blackwell. Lehne, R. A. (2013). Pharmacology for nursing care. (8th ed.). USA: Elsevier Saunders. Meeking, D. R. (2011). Understanding diabetes and endocrinology: A problem-orientated approach. UK: Manson Publishing Ltd. MIMS Australia. (2014). Mimsonline. Retrieved on 28.3.2014, from https://www-mimsonline-com-au.libraryproxy.griffith.edu.au/Search/Search.aspx. Mozaffari, M. S. (2013). New strategies to advance pre/diabetes care: Integrative approach by PPPM. USA: Springer. Reinhold, J. A., Earl, G. (2014). Clinical therapeutics primer: Link to the evidence for the ambulatory care pharmacist. USA: Jones Bartlett Learning. Unger, J. (2013). Diabetes management in primary care (2nd ed.). China: Williams Wilkins. MIMS Australia. (2014).