anti-diabetic medication - wikipedia, the free encyclopedia

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Anti-diabetic medicationFrom Wikipedia, the free encyclopedia

Anti-diabetic medications treat diabetes mellitus by lowering glucose levels in the blood. With the exceptions

of insulin, exenatide, liraglutide and pramlintide, all are administered orally and are thus also called oral

hypoglycemic agents ororal antihyperglycemic agents. There are different classes of anti-diabetic drugs,

and their selection depends on the nature of the diabetes, age and situation of the person, as well as other

factors.

Diabetes mellitus type 1 is a disease caused by the lack of insulin. Insulin must be used in Type I, which must be

injected.

Diabetes mellitus type 2 is a disease of insulin resistance by cells. Treatments include (1) agents that increase the

amount of insulin secreted by the pancreas, (2) agents that increase the sensitivity of target organs to insulin, and

(3) agents that decrease the rate at which glucose is absorbed from the gastrointestinal tract.

Several groups of drugs, mostly given by mouth, are effective in Type II, often in combination. The therapeutic

combination in Type II may include insulin, not necessarily because oral agents have failed completely, but insearch of a desired combination of effects. The great advantage of injected insulin in Type II is that a well-

educated patient can adjust the dose, or even take additional doses, when blood glucose levels measured by the

patient, usually with a simple meter, as needed by the measured amount of sugar in the blood.

Contents

1 Insulin

2 Comparison

3 Sensitizers

3.1 Biguanides

3.2 Thiazolidinediones

4 Secretagogues

4.1 Sulfonylureas

4.2 Nonsulfonylurea secretagogues

5 Alpha-glucosidase inhibitors

6 Peptide analogs

6.1 Injectable Incretin mimetics6.2 Injectable Amylin analogues

7 Natural substances

7.1 Plants

7.2 Elements

8 Generic

9 References

10 Further reading

Insulin

Main article: insulin
https://en.wikipedia.org/wiki/Insulinhttps://en.wikipedia.org/wiki/Anti-diabetic_medication#Referenceshttps://en.wikipedia.org/wiki/Anti-diabetic_medication#Plantshttps://en.wikipedia.org/wiki/Anti-diabetic_medication#Injectable_Incretin_mimeticshttps://en.wikipedia.org/wiki/Anti-diabetic_medication#Alpha-glucosidase_inhibitorshttps://en.wikipedia.org/wiki/Anti-diabetic_medication#Nonsulfonylurea_secretagogueshttps://en.wikipedia.org/wiki/Anti-diabetic_medication#Secretagogueshttps://en.wikipedia.org/wiki/Anti-diabetic_medication#Thiazolidinedioneshttps://en.wikipedia.org/wiki/Anti-diabetic_medication#Biguanideshttps://en.wikipedia.org/wiki/Anti-diabetic_medication#Sensitizershttps://en.wikipedia.org/wiki/Anti-diabetic_medication#Insulinhttps://en.wikipedia.org/wiki/Diabetes_mellitus_type_2https://en.wikipedia.org/wiki/Diabetes_mellitus_type_1https://en.wikipedia.org/wiki/Exenatidehttps://en.wikipedia.org/wiki/Liraglutidehttps://en.wikipedia.org/wiki/Pramlintidehttps://en.wikipedia.org/wiki/Insulinhttps://en.wikipedia.org/wiki/Anti-diabetic_medication#Further_readinghttps://en.wikipedia.org/wiki/Anti-diabetic_medication#Referenceshttps://en.wikipedia.org/wiki/Anti-diabetic_medication#Generichttps://en.wikipedia.org/wiki/Anti-diabetic_medication#Elementshttps://en.wikipedia.org/wiki/Anti-diabetic_medication#Plantshttps://en.wikipedia.org/wiki/Anti-diabetic_medication#Natural_substanceshttps://en.wikipedia.org/wiki/Anti-diabetic_medication#Injectable_Amylin_analogueshttps://en.wikipedia.org/wiki/Anti-diabetic_medication#Injectable_Incretin_mimeticshttps://en.wikipedia.org/wiki/Anti-diabetic_medication#Peptide_analogshttps://en.wikipedia.org/wiki/Anti-diabetic_medication#Alpha-glucosidase_inhibitorshttps://en.wikipedia.org/wiki/Anti-diabetic_medication#Nonsulfonylurea_secretagogueshttps://en.wikipedia.org/wiki/Anti-diabetic_medication#Sulfonylureashttps://en.wikipedia.org/wiki/Anti-diabetic_medication#Secretagogueshttps://en.wikipedia.org/wiki/Anti-diabetic_medication#Thiazolidinedioneshttps://en.wikipedia.org/wiki/Anti-diabetic_medication#Biguanideshttps://en.wikipedia.org/wiki/Anti-diabetic_medication#Sensitizershttps://en.wikipedia.org/wiki/Anti-diabetic_medication#Comparisonhttps://en.wikipedia.org/wiki/Anti-diabetic_medication#Insulinhttps://en.wikipedia.org/wiki/Diabetes_mellitus_type_2https://en.wikipedia.org/wiki/Diabetes_mellitus_type_1https://en.wikipedia.org/wiki/Pramlintidehttps://en.wikipedia.org/wiki/Liraglutidehttps://en.wikipedia.org/wiki/Exenatidehttps://en.wikipedia.org/wiki/Insulinhttps://en.wikipedia.org/wiki/Glucosehttps://en.wikipedia.org/wiki/Diabetes_mellitus


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Insulin is usually given subcutaneously, either by injections or by an insulin pump. Research of other routes of

administration is underway. In acute-care settings, insulin may also be given intravenously. In general, there are

three types of insulin, characterized by the rate which they are metabolized by the body. They are rapid acting

insulins, intermediate acting insulins and long acting insulins. Examples of rapid acting insulins include

Regular insulin (Humulin R, Novolin R)

Insulin lispro (Humalog)

Insulin aspart (Novolog)Insulin glulisine (Apidra)

Prompt insulin zinc (Semilente, Slightly slower acting)

Examples of intermediate acting insulins include

Isophane insulin, neutral protamine Hagedorn (NPH) (Humulin N, Novolin N)

Insulin zinc (Lente)

Examples of long acting insulins include

Extended insulin zinc insulin (Ultralente)

Insulin glargine (Lantus)

Insulin detemir (Levemir)

Comparison

The following table compares some common anti-diabetic agents, generalizing classes, although there may be

substantial variation in individual drugs of each class. When the table makes a comparison such as "lower risk"

or "more convenient" the comparison is with the other drugs on the table.

Comparison of anti-diabetic medication[1][2]

agent[2] mechanism[3] advantages[2] disadvantages[2]

Sulfonylurea

(glyburide,

glimepiride,

glipizide)

Stimulating insulin release by

pancreatic beta cells by inhibiting

the KATP channel

Inexpensive

Fast onset of

action

No effect on

bloodpressure

No effect on

low-density

lipoprotein

inexpensive

lower risk of

gastrointestinal

problems than

with

metformin

more

convenient

dosing

causes an average of 5

10 pounds weight gainIncreased risk of

hypoglycemia

Glyburide has increases

risk of hypoglycemia

slightly more as

compared with

glimepiride and glipizide

Higher risk of death

compared with

metformin[4]
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MetforminActs on liver to cause decrease in

insulin resistance

not associated

with weight

gain

low risk of

hypoglycemia

as compared

to alternatives

Good effect

on LDL

cholesterol

Decreases

triglycerides

no effect on

blood

pressure

inexpensive

increased risk of

gastrointestinal problems

Contraindicated for

people with moderate orsevere kidney disease or

heart failure because of

risk of lactic acidosis

increased risk of Vitamin

B12 deficiency[3]

less convenient dosing

Metallic taste[3]

Alpha-

glucosidase

inhibitor

(acarbose,

miglitol,

voglibose)

Reduces glucose absorbance by

acting on small intestine to cause

decrease in production of enzymes

needed to digest carbohydrates

slightly

decreased risk

of

hypoglycemia

as compared

to sulfonylurea

not associatedwith weight

gain

decreases

triglycerides

no effect on

cholesterol

less effective than most

other diabetes pills in

decreasing glycated

hemoglobin

increased risk of GI

problems than other

diabetes pills except

metformin

inconvenient dosing

expensive

Thiazolidinediones

(Pioglitazone,

Rosiglitazone)

Reduce insulin resistance by

activating PPAR- in fat and

muscle

Lower risk of

hypoglycemia

Slight increase

in high-densitylipoprotein

Actos linked

to decreased

increased risk of heartfailure

causes an average of 5

10 pounds weight gain

associated with higher

risk of edema

associated with higher

risk of anemia

increases low-density

lipoprotein

Avandia linked to

increased triglycerides

and risk of heart attack

Actos linked to
https://en.wikipedia.org/wiki/Anemiahttps://en.wikipedia.org/wiki/Edemahttps://en.wikipedia.org/wiki/Weight_gainhttps://en.wikipedia.org/wiki/Heart_failurehttps://en.wikipedia.org/wiki/High-density_lipoproteinhttps://en.wikipedia.org/wiki/Peroxisome_proliferator-activated_receptor_gammahttps://en.wikipedia.org/wiki/Rosiglitazonehttps://en.wikipedia.org/wiki/Pioglitazonehttps://en.wikipedia.org/wiki/Thiazolidinedioneshttps://en.wikipedia.org/wiki/Glycated_hemoglobinhttps://en.wikipedia.org/wiki/Small_intestinehttps://en.wikipedia.org/wiki/Voglibosehttps://en.wikipedia.org/wiki/Miglitolhttps://en.wikipedia.org/wiki/Acarbosehttps://en.wikipedia.org/wiki/Alpha-glucosidase_inhibitorhttps://en.wikipedia.org/wiki/Anti-diabetic_medication#cite_note-agabegi2nd-185-3https://en.wikipedia.org/wiki/Metallic_tastehttps://en.wikipedia.org/wiki/Anti-diabetic_medication#cite_note-agabegi2nd-185-3https://en.wikipedia.org/wiki/Vitamin_B12_deficiencyhttps://en.wikipedia.org/wiki/Lactic_acidosishttps://en.wikipedia.org/wiki/Heart_failurehttps://en.wikipedia.org/wiki/Kidney_diseasehttps://en.wikipedia.org/wiki/Human_gastrointestinal_tracthttps://en.wikipedia.org/wiki/Triglycerideshttps://en.wikipedia.org/wiki/LDL_cholesterolhttps://en.wikipedia.org/wiki/Insulin_resistancehttps://en.wikipedia.org/wiki/Metformin


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triglycerides

Convenient

dosing

increased risk of bladder

cancer

slower onset of action

requires monitoring for

hepatoxicity

associated with

increased risk of limb

fracturesexpensive

Most anti-diabetic agents are contraindicated in pregnancy, in which insulin is preferred.[3]

Sensitizers

Insulin sensitizers address the core problem in Type II diabetesinsulin resistance.

Biguanides

Main article: Biguanide

Biguanides reduce hepatic glucose output and increase uptake of glucose by the periphery, including skeletal

muscle. Although it must be used with caution in patients with impaired liver or kidney function, metformin, a

biguanide, has become the most commonly used agent for type 2 diabetes in children and teenagers. Among

common diabetic drugs, metformin is the only widely used oral drug that does not cause weight gain.

Typical reduction in glycated hemoglobin (A1C) values for metformin is 1.52.0%

Metformin (Glucophage) may be the best choice for patients who also have heart failure, [5] but it should

be temporarily discontinued before any radiographic procedure involving intravenous iodinated contrast,

as patients are at an increased risk of lactic acidosis.

Phenformin (DBI) was used from 1960s through 1980s, but was withdrawn due to lactic acidosis risk. [6]

Buformin also was withdrawn due to lactic acidosis risk.[7]

Metformin is usually the first-line medication used for treatment of type 2 diabetes. In general, it is prescribed at

initial diagnosis in conjunction with exercise and weight loss, as opposed to in the past, where it was prescribedafter diet and exercise had failed. There is an immediate release as well as an extended-release formulation,

typically reserved for patients experiencing GI side-effects. It is also available in combination with other oral

diabetic medications.

Thiazolidinediones

Main article: Thiazolidinedione

Thiazolidinediones (TZDs), also known as "glitazones," bind to PPAR, a type of nuclear regulatory protein

involved in transcription of genes regulating glucose and fat metabolism. These PPARs act on peroxysome

proliferator responsive elements (PPRE).[8] The PPREs influence insulin-sensitive genes, which enhance

production of mRNAs of insulin-dependent enzymes. The final result is better use of glucose by the cells.
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Typical reductions in glycated hemoglobin (A1C) values are 1.52.0%. Some examples are:

rosiglitazone (Avandia): the European Medicines Agency recommended in September 2010 that it be

suspended from the EU market due to elevated cardiovascular risks.[9]

pioglitazone (Actos)

troglitazone (Rezulin): used in 1990s, withdrawn due to hepatitis and liver damage risk[10]

Multiple retrospective studies have resulted in a concern about rosiglitazone's safety, although it is establishedthat the group, as a whole, has beneficial effects on diabetes. The greatest concern is an increase in the number

of severe cardiac events in patients taking it. The ADOPT study showed that initial therapy with drugs of this

type may prevent the progression of disease,[11] as did the DREAM trial.[12]

Concerns about the safety of rosiglitazone arose when a retrospective meta-analysis was published in the New

England Journal of Medicine.[13] There have been a significant number of publications since then, and a Food

and Drug Administration panel[14] voted, with some controversy, 20:3 that available studies "supported a signal

of harm," but voted 22:1 to keep the drug on the market. The meta-analysis was not supported by an interim

analysis of the trial designed to evaluate the issue, and several other reports have failed to conclude the

controversy. This weak evidence for adverse effects has reduced the use of rosiglitazone, despite its importantand sustained effects on glycemic control.[15] Safety studies are continuing.

In contrast, at least one large prospective study, PROactive 05, has shown that pioglitazone may decrease the

overall incidence of cardiac events in people with type 2 diabetes who have already had a heart attack.[16]

Secretagogues

These are the drugs that increase Insulin output from Pancreas.

Sulfonylureas

Main article: Sulfonylurea

Sulfonylureas were the first widely used oral anti-hyperglycaemic medications. They are insulin secretagogues,

triggering insulin release by inhibiting the KATP channel of the pancreatic beta cells. Eight types of these pills

have been marketed in North America, but not all remain available. The "second-generation" drugs are now

more commonly used. They are more effective than first-generation drugs and have fewer side-effects. All may

cause weight gain. A 2012 study found sulfonylureas raise the risk of death compared with metformin. [4]

Sulfonylureas bind strongly to plasma proteins. Sulfonylureas are useful only in Type II diabetes, as they work

by stimulating endogenous release of insulin. They work best with patients over 40 years old who have had

diabetes mellitus for under ten years. They cannot be used with type I diabetes, or diabetes of pregnancy. They

can be safely used with metformin or -glitazones. The primary side-effect is hypoglycemia.

Typical reductions in glycated hemoglobin (A1C) values for second-generation sulfonylureas are 1.02.0%.

First-generation agents

tolbutamide (Orinase brand name )

acetohexamide (Dymelor)

tolazamide (Tolinase)

chlorpropamide (Diabinese)

Second-generation agents
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glipizide (Glucotrol)

glyburide or glibenclamide (Diabeta, Micronase, Glynase)

glimepiride (Amaryl)

gliclazide (Diamicron)

glycopyramide

gliquidone

Nonsulfonylurea secretagogues

Meglitinides

Main article: Meglitinide

Meglitinides help the pancreas produce insulin and are often called "short-acting secretagogues." They act on the

same potassium channels as sulfonylureas, but at a different binding site.[17] By closing the potassium channels o

the pancreatic beta cells, they open the calcium channels, thereby enhancing insulin secretion. [18]

They are taken with or shortly before meals to boost the insulin response to each meal. If a meal is skipped, the

medication is also skipped.

Typical reductions in glycated hemoglobin (A1C) values are 0.51.0%.

repaglinide (Prandin)

nateglinide (Starlix)

Adverse reactions include weight gain and hypoglycemia.

Alpha-glucosidase inhibitors

Main article: Alpha-glucosidase inhibitor

Alpha-glucosidase inhibitors are "diabetes pills" but not technically hypoglycemic agents because they do not

have a direct effect on insulin secretion or sensitivity. These agents slow the digestion of starch in the small

intestine, so that glucose from the starch of a meal enters the bloodstream more slowly, and can be matched

more effectively by an impaired insulin response or sensitivity. These agents are effective by themselves only in

the earliest stages of impaired glucose tolerance, but can be helpful in combination with other agents in type 2

diabetes.

Typical reductions in glycated hemoglobin (A1C) values are 0.51.0%.

miglitol (Glyset)

acarbose (Precose/Glucobay)

voglibose

These medications are rarely used in the United States because of the severity of their side-effects (flatulence

and bloating). They are more commonly prescribed in Europe. They do have the potential to cause weight loss

by lowering the amount of sugar metabolized.

Research has shown that the culinary mushroom maitake (Grifola frondosa) has a hypoglycemic

effect,[19][20][21][22][23][24] possibly due to the mushroom acting as a natural alpha glucosidase inhibitor.[25]
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Overview of insulin secretion

Peptide analogs

Injectable Incretin mimetics

Incretins are insulin secretagogues. The two main

candidate molecules that fulfill criteria for being an

incretin are glucagon-like peptide-1 (GLP-1) and gastric

inhibitory peptide (glucose-dependent insulinotropic

peptide, GIP). Both GLP-1 and GIP are rapidly

inactivated by the enzyme dipeptidyl peptidase-4 (DPP-

4).

Injectable Glucagon-like peptide analogs and

agonists

Glucagon-like peptide (GLP) agonists bind to a

membrane GLP receptor.[18] As a consequence, insulinrelease from the pancreatic beta cells is increased.

Endogenous GLP has a half-life of only a few minutes, thus an analogue of GLP would not be practical.

Exenatide (also Exendin-4, marketed as Byetta) is the first GLP-1 agonist approved for the treatment of

type 2 diabetes. Exenatide is not an analogue of GLP but rather a GLP agonist.[26][27] Exenatide has only

53% homology with GLP, which increases its resistance to degradation by DPP-4 and extends its half-

life.[28] Typical reductions in A1C values are 0.51.0%.

Liraglutide, a once-daily human analogue (97% homology), has been developed by Novo Nordisk under

the brand name Victoza. The product was approved by the European Medicines Agency (EMEA) on

July 3, 2009, and by the U.S. Food and Drug Administration (FDA) on January 25,

2010.[29][30][31][32][33][34]

Taspoglutide is presently in Phase III clinical trials with Hoffman-La Roche.

These agents may also cause a decrease in gastric motility, responsible for the common side-effect of nausea,

and is probably the mechanism by which weight loss occurs.

Gastric inhibitory peptide analogs

None are FDA approved

Dipeptidyl Peptidase-4 Inhibitors

Main article: Dipeptidyl peptidase-4 inhibitors

GLP-1 analogs resulted in weight loss and had more gastrointestinal side-effects, while in general DPP-4

inhibitors were weight-neutral and increased risk for infection and headache, but both classes appear to present

an alternative to other antidiabetic drugs. However, weight gain and/or hypoglycaemia have been observed

when DPP-4 inhibitors were used with sulfonylureas; effect on long-term health and morbidity rates are stillunknown.[35]

Dipeptidyl peptidase-4 (DPP-4) inhibitors increase blood concentration of the incretin GLP-1 by inhibiting its

degradation by dipeptidyl peptidase-4.
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Examples are:

vildagliptin (Galvus) EU Approved 2008

sitagliptin (Januvia) FDA approved Oct 2006

saxagliptin (Onglyza) FDA Approved July 2009

linagliptin (Tradjenta) FDA Approved May 2, 2011

allogliptin

septagliptin

DPP-4 inhibitors lowered hemoglobin A1C values by 0.74%, comparable to other antidiabetic drugs. [36]

A result in one RCT comprising 206 patients aged 65 or older (mean baseline HgbA1c of 7.8%) receiving

either 50 or 100 mg/d of Sitagliptin was shown to reduce HbA1c by 0.7% (combined result of both doses).[37]

A combined result of 5 RCTs enlisting a total of 279 patients aged 65 or older (mean baseline HbA1c of 8%)

receiving 5 mg/d of Saxagliptin was shown to reduce HbA1c by 0.73%.[38] A combined result of 5 RCTs

enlisting a total of 238 patients aged 65 or older (mean baseline HbA1c of 8.6%) receiving 100 mg/d of

Vildagliptin was shown to reduce HbA1c by 1.2%.[39] Another set of 6 combined RCTs involving Alogliptin

(not yet approved, might be released in 2012) was shown to reduce HbA1c by 0.73% in 455 patients aged 65or older who received 12.5 or 25 mg/d of the medication.[40]

Injectable Amylin analogues

Amylin agonist analogues slow gastric emptying and suppress glucagon. They have all the incretins actions

except stimulation of insulin secretion. As of 2007, pramlintide is the only clinically available amylin analogue.

Like insulin, it is administered by subcutaneous injection. The most frequent and severe adverse effect of

pramlintide is nausea, which occurs mostly at the beginning of treatment and gradually reduces. Typical

reductions in A1C values are 0.51.0%.

Natural substances

Plants

A number of medicinal plants have been studied for the treatment of diabetes, however there is insufficient

evidence to determine their effectiveness.[41] Cinnamon has blood sugar-lowering properties, however whether

or not it is useful for treating diabetes is unknown.[42] Researchers from Australia's Swinburne University have

found extracts from Australian Sandalwood and Indian Kino tree slows down two key enzymes in carbohydratemetabolism. [43] Bioassay-directed fractionation techniques led to isolation of isoorientin as the main

hypoglycemic component in Gentiana olivieri.[44]

Elements

While chromium supplements have no beneficial effect on healthy people, there might be an improvement in

glucose metabolism in individuals with diabetes, although the evidence for this effect remains weak.[45] Vanadyl

sulfate, a salt of vanadium, is still in preliminary studies.[46] There is tentative research that thiamine may prevent

some diabetic complications however more research is needed.[47]

Generic
https://en.wikipedia.org/wiki/Anti-diabetic_medication#cite_note-47https://en.wikipedia.org/wiki/Thiaminehttps://en.wikipedia.org/wiki/Anti-diabetic_medication#cite_note-46https://en.wikipedia.org/wiki/Vanadiumhttps://en.wikipedia.org/wiki/Anti-diabetic_medication#cite_note-45https://en.wikipedia.org/wiki/Anti-diabetic_medication#cite_note-44https://en.wikipedia.org/wiki/Gentiana_olivierihttps://en.wikipedia.org/wiki/Isoorientinhttps://en.wikipedia.org/wiki/Bioassay-directed_fractionationhttps://en.wikipedia.org/wiki/Anti-diabetic_medication#cite_note-43https://en.wikipedia.org/wiki/Indian_Kino_treehttps://en.wikipedia.org/wiki/Australian_Sandalwoodhttps://en.wikipedia.org/wiki/Anti-diabetic_medication#cite_note-42https://en.wikipedia.org/wiki/Cinnamonhttps://en.wikipedia.org/wiki/Anti-diabetic_medication#cite_note-41https://en.wikipedia.org/wiki/Nauseahttps://en.wikipedia.org/wiki/Subcutaneous_injectionhttps://en.wikipedia.org/wiki/Pramlintidehttps://en.wikipedia.org/wiki/Glucagonhttps://en.wikipedia.org/wiki/Amylinhttps://en.wikipedia.org/wiki/Anti-diabetic_medication#cite_note-40https://en.wikipedia.org/wiki/Alogliptinhttps://en.wikipedia.org/wiki/Anti-diabetic_medication#cite_note-39https://en.wikipedia.org/wiki/Vildagliptinhttps://en.wikipedia.org/wiki/Anti-diabetic_medication#cite_note-38https://en.wikipedia.org/wiki/Saxagliptinhttps://en.wikipedia.org/wiki/Anti-diabetic_medication#cite_note-37https://en.wikipedia.org/wiki/Sitagliptinhttps://en.wikipedia.org/wiki/Anti-diabetic_medication#cite_note-pmid17622601-36https://en.wikipedia.org/wiki/Glycated_hemoglobinhttps://en.wikipedia.org/wiki/DPP-4_inhibitorshttps://en.wikipedia.org/w/index.php?title=Septagliptin&action=edit&redlink=1https://en.wikipedia.org/w/index.php?title=Allogliptin&action=edit&redlink=1https://en.wikipedia.org/wiki/Linagliptinhttps://en.wikipedia.org/wiki/Saxagliptinhttps://en.wikipedia.org/wiki/Sitagliptinhttps://en.wikipedia.org/wiki/Vildagliptin


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Many anti-diabetes drugs are available as generic. It are:[48]

Sulfonylureas - Glimepiride, Glipizide, Glyburide

Biguanides - Metformin

Thiazolidinediones (Tzd) - Pioglitazone, Actos generic

Alpha-glucosidase inhibitors - Acarbose

Meglitinides - Nateglinide

Combination of Sulfonylureas plus Metformin - known by generic names of the two drugs

No generic for Dipeptidyl peptidase-4 inhibitors (Januvia, Onglyza) and Others Combinations

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36. ^ Amori RE, Lau J, Pittas AG (2007). "Efficacy and safety of incretin therapy in type 2 diabetes: systematic

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Retrieved July 17, 2013.

Further reading

Lebovitz, Harold E. (2004). Therapy For Diabetes Mellitus and Related Disorders (4th ed.). Alexandria, VA:

American Diabetes Association. ISBN 1-58040-187-2.

Adams, Michael Ian; Holland, Norman Norwood (2003). Core Concepts in Pharmacology. Englewood Cliffs,

NJ: Prentice Hall. ISBN 0-13-089329-3.

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