Learning unit: Antidiabetics

Impact of the learning unit:

The number of diabetic patients has been growing recently. Diabetes is a chronic metabolic disease
with different etiopathology. Hyperglycemia is the common feature due to the insufficient effect of
insulin through its relative or absolute deficiency. More than 90% of diabetic patients have type
II diabetes (i.e., with relative insulin deficiency). Treatment of this disease is associated with
high health care costs, and antidiabetic (hypoglycemic) drugs are the basis of treatment. Thus,
knowledge of their pharmacology is necessary to use them correctly in the clinical practice.

Relevant terms

targets affected by antidiabetic drugs

insulin resistance

PPAR receptors

secretion of insulin

renal threshold for glucose

incretin system

oral hypoglycemic agents

                biguanides

                               metformin

                                               lactate acidosis as an adverse effect

                sulfonylureas

                               glibenclamide

                               gliclazide

                                               weight gain as an adverse effect, hypoglycemia as an
adverse effect

                                               pharmacokinetic interactions

                thiazolidinediones

                               pioglitazone

                                               PPAR receptors – types, function (overview)

                alpha-glucosidase inhibitors

                               acarbose

                meglitinides

                               repaglinide

                SGLT2 inhibitors (gliflozines, glycosurics)

                               empagliflozin

DPP-4 inhibitors (gliptins)

                               sitagliptin

                               Incretin system

injectable antidiabetic agents

GLP1 analogues (incretin mimetics)

                               exenatide


Learning outcomes

Student differs antidiabetic agents according to their route of administration and gives advantages
and disadvantages of such administration.

Student explains mechanisms by which antidiabetics influence insulin secretion or insulin
resistance. Student is aware of drug groups able to induce hypoglycemia and knows other adverse
effects, including potential influence on body weight.

Student knows basic pharmacological profile (mode of action, unwanted effects, indications and
contraindications) of antidiabetics.

Student describes an algorithm for choosing an antidiabetic agent for a model patient.

Study materials

Rang & Dale's Pharmacology, 8th edition, 2016, chapter 31 (The control of blood glucose and drug
treatment of diabetes mellitus)

Study materials for courses aVLFA0721p and aVLFA0721c.


Exam questions

Special pharmacology:  8. Antidiabetics (except insulines)

Essential drugs: 23. metformine, 24. glimepiride, 25. sitagliptin