M. Hulusi ATMACA, Gülçin CENGİZ ECEMİŞ

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Oral antidiyabetik ajanlar

Diabetes mellitus tüm dünyada prevalansı gittikçe artan kronik bir hastalıktır. Farmakolojik tedavi optimal glisemik kontrolü sağlamak için çoğu zaman gereklidir. Günümüzde klinisyenlere tip 2 diyabet tedavisi için çok geniş yelpazede oral antidiyabetik ilaçlar sunulmaktadır. Bu oral antidiyabetik ilaçlar; insülin sekresyonunu stimüle edenler (sülfonilüreler ve hızlı etkili sekretagoglar), hepatik glukoz üretimini azaltanlar (biguanidler), intestinal karbonhidrat sindirimi ve emilimini geciktirenler (α-glukozidaz inhibitörleri) ve insülin etkisini iyileştirenler (tiazolidindionlar) olarak ayrılabilir. Bu makalede farklı oral antidiyabetik ilaçların etki mekanizmaları, etkinlikleri ve yan etkileri ile birlikte kullanımları ile ilgili en son öneriler tartışılacaktır.
Anahtar Kelimeler:

Sekretagoglar, Sülfonilüreler, Diabetes Mellitus, Biguanidler, α-Glukozidaz İnhibitörleri, Tiazolidindionlar

Oral antidiabetic agents

Diabetes mellitus is a chronic disease that is growing in prevalence worldwide. Pharmacologic therapy is often necessary to achieve optimal glycemic control in the management of diabetes. Today’s clinicians are presented with an extensive range of oral antidiabetic drugs for type 2 diabetes. These main drug classes include agents that stimulate insulin secretion (sulphonylureas and rapid-acting secretagogues), reduce hepatic glucose production (biguanides), delay digestion and absorption of intestinal carbohydrate (α-glucosidase inhibitors) or improve insulin action (thiazolidinediones). We review the mechanism of action, efficacy and side effects of the different classes of oral antidiabetic drugs and discuss the current recommendations for their use.
Keywords:

Diabetes Mellitus, Sulphonylureas, Secretagogues, Biguanides, α-Glucosidase Inhibitors, Thiazolidinediones,

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  • American Diabetes Association. 2011. Diabetes Care. 34, 1-96.
  • Aronoff, S., Rosenblatt, S., Braithwaite, S., Egan, J.W., Mathisen, A.L., Schneider, R.L., 2000. Pioglitazone hydrochloride monotherapy im- proves glycemic control in the treatment of patients with type 2 diabetes: A 6-month randomized placebo-controlled dose-response study. Diabetes Care. 23, 1605-1611.
  • Bailey, C.J., Turner, R.C., 1996. Metformin. N. Engl. J. Med. 334, 574-579.
  • Basu, A., Jensen, M.D., McCann, F., Mukhopadhyay, D., Joyner, M.J., Rizza, R.A, 2006. Effects of pioglitazone versus glipizide on body fat distribution, body water content, and hemodynamics in type 2 diabetes. Diabetes Care. 29, 510-514.
  • Bauman, W.A., Shaw, S., Jayatilleke, E., Spungen, A.M., Herbert, V., 2000. Increased intake of calcium reverses vitamin B12 malabsorption induced by metformin. Diabetes Care. 23, 1227-1231.
  • Bell, D.S., 2006. Do sulfonylurea drugs increase the risk of cardiac events? CMAJ. 174, 185- 186.
  • Bowker, S.L., Majumdar, S.R., Veugelers, P., Johnson, J.A., 2006. Increased cancer-related mortality for patients with type 2 diabetes who use sulfonylureas or insulin. Diabetes Care. 29, 254-258.
  • Bressler, R., Johnson, D.G., 1997. Pharmacological regulation of blood glucose levels in non- insulin-dependent diabetes mellitus. Arch. Intern. Med. 157, 836-848.
  • Buse, J.B., Polonsky, K.S., Burant, C.F., 2008. Type 2 Diabetes Mellitus, in Williams Textbook of Endocrinology, Vol 30, Kronenberg HM, Melmed S, Polonsky KS, Larsen PR eds, Saunders Elsevier, Philadelphia, pp. 1329-1389.
  • Cheng, A.Y., Fantus, I.G., 2005. Oral antihyperglycemic therapy for type 2 diabetes mellitus. CMAJ. 172, 213-226.
  • Çorakçı A, Azal Ö, Beyhan Z, 2009. Diabetes Mellitus’ta Oral Ajan Tedavisi, in Diabetes Mellitus 2009 Multidisipliner Yaklaşımla Tanı, Te- davi ve İzlem, Vol 9, İmamoğlu Ş, Ersoy Özyardımcı C eds, Deomed, İstanbul, 137-176
  • DeFronzo, R.A., 1999. Pharmacologic therapy for type 2 diabetes mellitus. Ann. Intern. Med. 131, 281-303.
  • Evans, J.M., Donnelly, L.A., Emslie-Smith, A.M., Alessi, D.R., Morris, A.D., 2005. Metformin and reduced risk of cancer in diabetic patients. BMJ. 330, 1304-1305.
  • Harrigan, R.A., Nathan, M.S., Beattie, P., 2001. Oral agents for the treatment of type 2 diabetes mellitus: Pharmacology, toxicity, and treatment. Ann. Emerg. Med. 38, 68-78.
  • Harrower, A.D., 1994. Comparison of efficacy, secondary failure rate, and complications of sulfonylureas. J. Diabetes Complicat. 8, 201-203.
  • Harrower, A.D., 2000. Comparative tolerability of sulphonylureas in diabetes mellitus. Drug Saf. 22, 313-320.
  • Hermann, L.S., Scherstén, B., Bitzén, P.O., Kjellström, T., Lindgärde, F., Melander, A., 1994. Therapeutic comparison of metformin and sulfo- nylurea, alone and in various combinations. A double-blind controlled study. Diabetes Care. 17, 1100-1109.
  • Inzucchi, S.E., 2002. Oral antihyperglycemic therapy for type 2 diabetes: Scientific review. JAMA. 287, 360-372.
  • Krentz, A.J., Bailey, C.J., 2005. Oral antidiabetic agents: Current role in type 2 diabetes mellitus. Drugs. 65, 385-411.
  • Langer, O., Yogev, Y., Xenakis, E.M., Rosenn, B., 2005. Insulin and glyburide therapy: Dosage, severity level of gestational diabetes, and preg- nancy outcome. Am. J. Obstet. Gynecol. 192, 134-139.
  • Lebovitz, H.E., 2001. Oral therapies for diabetic hyperglycemia. Endocrinol. Metab. Clin. North Am. 30, 909-933.
  • Lebovitz, H.E., 2005. Management of hyperglycemia with oral antihyperglycemic agents in Type 2 diabetes, in Joslin’s Diabetes Mallitus, Vol 41, Kahn CR, Weir GC, King GL, Jacobson AM, Moses AC, Smith RJ eds, Lipincott Williams & Wilkins, Boston, pp. 687-710.
  • Levetan, C., 2007. Oral antidiabetic agents in type 2 diabetes. Curr. Med. Res. Opin. 23, 945-952.
  • Masharani, U., German, M.S., 2007. Pancreatic Hormones & Diabetes Mellitus, in Greenspan’s Basic & Clinical Endocrinology, Vol 18, Gard- ner DG, Shoback D eds, McGraw-Hill Company, USA, pp. 661-747.
  • Meier, C., Kraenzlin, M.E., Bodmer, M., Jick, S.S., Jick, H., Meier, C.R., 2008. Use of thiazolidinediones and fracture risk. Arch. Intern. Med. 168, 820-825.
  • Mizuno, C.S., Chittiboyina, A.G., Kurtz, T.W., Pershadsingh, H.A., Avery, M.A., 2008. Type 2 diabetes and oral antihyperglycemic drugs. Curr Med. Chem. 15, 61-74.
  • Nyenwe, E.A., Jerkins, T.W., Umpierrez, G.E., Kitabchi, A.E., 2011. Management of type 2 diabetes: Evolving strategies for the treatment of patients with type 2 diabetes. Metabolism. 60, 1-23.
  • Park, K.S., Ciaraldi, T.P., Abrams-Carter, L., Mudaliar, S., Nikoulina, S.E., Henry, R.R., 1997. PPAR-gamma gene expression is elevated in skeletal muscle of obese and type II diabetic subjects. Diabetes. 46, 1230-1234.
  • Rendell, M., 2004. The role of sulphonylureas in the management of type 2 diabetes mellitus. Drugs. 64, 1339-1358.
  • Rosenstock, J., Hassman, D.R., Madder, R.D., Brazinsky, S.A., Farrell, J., Khutoryansky, N., Hale, P.M., 2004. Repaglinide Versus Nateglinide Comparison Study Group. Repaglinide versus nateglinide monotherapy: A randomized, multicenter study. Diabetes Care. 27, 1265-1270.
  • Stafylas, P.C., Sarafidis, P.A., Lasaridis, A.N., 2009. The controversial effects of thiazolidinediones on cardiovascular morbidity and mortality. Int. J. Cardiol. 131, 298- 304.
  • Ting, R.Z., Szeto, C.C., Chan, M.H., Ma, K.K., Chow, K.M., 2006. Risk factors of vitamin B12 deficiency in patients receiving metformin. Arch. Intern. Med. 166, 1975-1979.
  • Yki-Järvinen, H., 2004. Thiazolidinediones. N. Eng. J. Med. 351, 1106-1118.
Journal of Experimental and Clinical Medicine-Cover
  • Yayın Aralığı: Yılda 4 Sayı
  • Başlangıç: 1980
  • Yayıncı: Ondokuz mayıs Üniversitesi Tıp Fakültesi
Arşiv
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