Non-Pharmacological Therapy for Diabetes
Before initiating oral antidiabetic therapy, non-pharmacological interventions are essential to manage diabetes. These include:
1. Dietary Modifications:
• Adopt a balanced diet with controlled carbohydrates, high fiber, and low glycemic index foods.
• Limit intake of refined sugars, trans fats, and excessive sodium.
• Follow individualized meal plans as guided by a dietitian.
2. Physical Activity:
• Encourage regular aerobic exercise (e.g., walking, swimming, cycling) for at least 150 minutes per week.
• Include resistance training to improve insulin sensitivity.
3. Weight Management:
• For overweight or obese patients, weight loss of 5–10% can significantly improve glycemic control.
4. Behavioral and Lifestyle Changes:
• Quit smoking and reduce alcohol consumption.
• Manage stress through relaxation techniques or therapy.
5. Monitoring Blood Glucose Levels:
• Self-monitoring of blood glucose (SMBG) to maintain awareness and adjusted lifestyle strategies accordingly.
6. Education and Support:
• Diabetes self-management education(DSME) to improve adherence and outcome
: Pharmacological Therapy of Oral Antidiabetic Drugs
Oral antidiabetic drugs are categorized based on their mechanisms of action:
1. Insulin Secretagogues (Increase insulin secretion):
• Sulfonylureas (e.g., Glimepiride, Glyburide, Glipizide):
Stimulate pancreatic beta cells to release insulin.
• Meglitinides (e.g., Repaglinide, Nateglinide):
Act on beta cells for rapid and short-term insulin release post-meal.
2. Insulin Sensitizers (Improve insulin sensitivity):
• Biguanides (e.g., Metformin):
Decrease hepatic glucose production and improve insulin sensitivity in peripheral tissues.
• Thiazolidinediones (TZDs) (e.g., Pioglitazone, Rosiglitazone):
Enhance insulin sensitivity in muscle and adipose tissue.
3. Alpha-Glucosidase Inhibitors (Delay carbohydrate absorption):
• Acarbose, Miglitol:
Inhibit intestinal alpha-glucosidase enzymes, slowing carbohydrate digestion and absorption.
4. Dipeptidyl Peptidase-4 (DPP-4) Inhibitors:
• Sitagliptin, Saxagliptin, Linagliptin:
Prolong action of incretin hormones, enhancing insulin secretion and reducing glucagon release.
5. Sodium-Glucose Co-Transporter-2 (SGLT-2) Inhibitors:
• Empagliflozin, Canagliflozin, Dapagliflozin:
Promote glucose excretion in urine by inhibiting renal glucose reabsorption.
6. Glucagon-Like Peptide-1 (GLP-1) Receptor Agonists (Oral Formulations):
• Semaglutide (oral):
Mimics incretin to increase insulin release and suppress glucagon.
7. Combination Therapies:
• Fixed-dose combinations (e.g., Metformin + Sitagliptin, Metformin + Empagliflozin) are often used to target multiple mechanisms simultaneously.
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