newer antidiabetic agents.pptx

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Metabolic disorder characterized by hyperglycemia, glycosuria, ketonemia and negative nitrogen balance

Responsible for morbidity, not only in the developed countries but is gradually reaching epidemic proportions in the developing countries too

With the increased prevalence of obesity in the general population, especially in young adults, the prevalence of diabetes is also on the rise, hence diabetes has been redefined as ‘diabesity’ or ‘obesity dependent diabetes mellitus

As per International Diabetes Federation [IDF] Diabetes Atlas, 285 million people worldwide now suffer from diabetes

If the current rate of growth continues unchecked number is expected to exceed 435 million in 2030

DIABETES MELLITUS

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Number of Cases with diabetes (20-79 years)

S. No. Country/Territory 2010(Millions)

2030(Millions)

1 India 50.8 87

2 China 43.2 62.6

3 USA 26.8 36.0

4 Russian Federation 9.6 10.3

5 Brazil 7.6 12.7

6 Germany 7.5 -

7 Pakistan 7.1 13.8

8 Japan 7.1 -

9 Indonesia 7.0 12.0

10 Mexico 6.8 11.9

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Universal symbol for diabetes

BLUE CIRCLE

“World Diabetes day was introduced in 1991 and is celebrated every year on November 14”. The day was

chosen to honor Frederick Banting (November 14, which is also his birthday), who along with Charles Best, first

conceived the idea that led to the discovery of insulin in 1921.

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TYPE 1 DIABETES MELLITUS (T1DM)

TYPE 2 DIABETES MELLITUS (T2DM)

GESTATIONAL DIABETES MELLITUS

Diabetes Mellitus

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TYPE 1 DIABETES MELLITUS (T1DM)

T1DM which was previously encompassed by the terms

insulin-dependent diabetes, type 1 diabetes, or juvenile-

onset diabetes

Accounts for only 5–10% of the cases

Cellular-mediated autoimmune destruction of the β-

cells of the pancreas

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TYPE 2 DIABETES MELLITUS (T2DM)

T2DM previously referred to as non–insulin dependent

diabetes, type 2 diabetes, or adult-onset diabetes

Accounts for approximately 90–95% of diabetes cases

The risk of developing T2DM increases with age,

obesity, and lack of physical activity

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GESTATIONAL DIABETES

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Complications of Diabetes Mellitus

Diabetes

Mellitus

Retinopathy

(26%)

Nephropathy

(5%)

Cardiovascular

Disorders

(17%)

Neuropathy

(28%)

Peripheral

Vascular Disorders

(6%)

Cerebrovascular

Disorders

(1%)

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NORMAL GLUCOSE UPTAKE

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T1DM

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T2DM

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Type-2 Diabetes Mellitus

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DIAGNOSIS OF DIABETES MELLITUS

Fasting plasma glucose test (FPG;>126 mg/dl)

Oral glucose tolerance test (OGTT; >200 mg/dl 2 hr after

glucose challenge) glycation of hemoglobin A (HbA1c levels).8

HbA1c has been considered as the gold standard for glycemic

control monitoring.

In general, every percentage point drop in HbA1c reduces

the risk of microvascular complications by 40%. Other tests that are relevant for tracking disease progression

include fasting insulin to glucose ratios (insulin sensitivity) and lipid levels

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Current drug therapies used for the management of T2DM

Class of drug Drugs Role

Sulfonylureas

1st generation

2nd generation

3rd generation

Acetohexamide, Chlorpropamide,

Tolbutamide, TolazamideInsulin secretagogues

Glibenclamide, Glyburide,

Glipizide Insulin secretagogues

Glimepiride Insulin secretagogues

Meglitinides(Glinides)

Repaglinide, Nateglinide Insulin secretagogues

Biguanides Metformin, PhenforminInsulin sensitizers

Thiazolidinediones(PPAR γ agonists; Glitazones)

Rosiglitazone, Pioglitazone,Insulin sensitizers

Gliptins(DPP-1V inhibitors)

Sitagliptin, Saxagliptin Insulin secretagogues

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New Targets For The Management of T2DM

Target Role

Glycogen Synthase Kinase-3 (GSK-3) Inhibitors Activation of glycogen synthase

PPAR α/γ dual agonist Insulin sensitizers

Na+ glucose co-transporter (SGLT) inhibitors Inhibits renal glucose reabsorption from urine

HGO Inhibitors Insulin sensitizers & decrease insulin resistance

β3- Adrenoreceptor Agonist Decreases food consumption

Retinoid X receptor Controls lipid and carbohydrate metabolism

Protein Tyrosine Phosphatase 1B (PTP 1B) inhibitors

Prevents dephosphorylation of activated insulin receptor

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Algorithm for the treatment of diabetes

THANKS

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