Diabetes

 Diabetes is a chronic metabolic condition where the body either does not produce enough insulin or cannot effectively use the insulin it produces. This leads to elevated blood sugar (glucose) levels. There are two primary types of diabetes:

1. Type 1 Diabetes: The body does not produce insulin.
2. Type 2 Diabetes: The body either becomes resistant to insulin or does not produce enough.

Medicines Used in Diabetes Treatment (India)

Here’s a list of common medications used to manage diabetes, their mechanism of action, and brand names commonly available in India:

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1. Metformin

• Mechanism of Action: Decreases hepatic glucose production and improves insulin sensitivity in muscle cells. It reduces glucose absorption from the intestines.
• Brand Names in India:
  • Glyciphage
  • Gluformin
  • Glucophage

2. Sulfonylureas

• Mechanism of Action: Stimulates the pancreas to produce more insulin. These drugs bind to sulfonylurea receptors on beta cells in the pancreas to stimulate insulin release.
• Common Drugs:
  • Glibenclamide (Glyburide)
  • Glipizide
  • Gliclazide
  • Glimepiride
• Brand Names in India:
  • Daonil (Glibenclamide)
  • Amaryl (Glimepiride)
  • Glizid (Gliclazide)
  • Glucotrol (Glipizide)

3. DPP-4 Inhibitors (Gliptins)

• Mechanism of Action: Inhibits the enzyme DPP-4, which degrades incretin hormones. Incretins increase insulin release and decrease glucagon levels, leading to lower blood glucose.
• Common Drugs:
  • Sitagliptin
  • Saxagliptin
  • Vildagliptin
  • Linagliptin
• Brand Names in India:
  • Januvia (Sitagliptin)
  • Onglyza (Saxagliptin)
  • Galvus (Vildagliptin)
  • Trajenta (Linagliptin)

4. SGLT-2 Inhibitors (Gliflozins)

• Mechanism of Action: Inhibits sodium-glucose co-transporter 2 (SGLT2) in the kidneys, which results in excess glucose being excreted in the urine.
• Common Drugs:
  • Canagliflozin
  • Dapagliflozin
  • Empagliflozin
• Brand Names in India:
  • Invokana (Canagliflozin)
  • Forxiga (Dapagliflozin)
  • Jardiance (Empagliflozin)

5. Thiazolidinediones (Glitazones)

• Mechanism of Action: Improve insulin sensitivity by acting on the peroxisome proliferator-activated receptors (PPARs), mainly PPARγ, which regulate genes involved in glucose and lipid metabolism.
• Common Drugs:
  • Pioglitazone
  • Rosiglitazone (rarely used due to cardiovascular risk concerns)
• Brand Names in India:
  • Pioz (Pioglitazone)
  • Glizone (Pioglitazone)
  • Avandia (Rosiglitazone)

6. Insulin

• Mechanism of Action: Replaces or supplements the body's insulin to control blood sugar levels. Various formulations act for different durations (short, intermediate, long-acting).
• Common Types:
  • Regular Insulin (Short-acting)
  • Insulin NPH (Intermediate-acting)
  • Insulin Glargine (Long-acting)
  • Insulin Aspart, Insulin Lispro (Rapid-acting)
• Brand Names in India:
  • Mixtard (Insulin Regular + NPH)
  • Lantus (Insulin Glargine)
  • Novorapid (Insulin Aspart)
  • Humalog (Insulin Lispro)

7. GLP-1 Receptor Agonists

• Mechanism of Action: Mimics the incretin hormone GLP-1, which increases insulin secretion, reduces glucagon release, and slows gastric emptying.
• Common Drugs:
  • Exenatide
  • Liraglutide
• Brand Names in India:
  • Byetta (Exenatide)
  • Victoza (Liraglutide)

8. Alpha-Glucosidase Inhibitors

• Mechanism of Action: Delays the digestion and absorption of carbohydrates by inhibiting the alpha-glucosidase enzyme in the intestines, leading to a slower rise in blood glucose after meals.
• Common Drugs:
  • Acarbose
  • Miglitol
• Brand Names in India:
  • Glucobay (Acarbose)
  • Miglitol is less commonly used.

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Combination Therapies

In India, combination drugs are often prescribed to provide better glycemic control. These may combine two or more drug classes, such as:

• Metformin + Sulfonylurea
• Metformin + DPP-4 inhibitor
• Metformin + SGLT-2 inhibitor

Common Combination Brand Names in India:

• Janumet (Metformin + Sitagliptin)
• Glycomet GP (Metformin + Glimepiride)
• Xigduo (Metformin + Dapagliflozin)

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Conclusion

The choice of medication depends on the individual's type of diabetes, their response to the medication, and other factors like kidney function, heart disease, and obesity. Many of these drugs are often used in combination to achieve better blood sugar control.