Hypoglycemic Agent

Prof. DR. dr. Hadyanto Lim, M.Kes,SpFK,FESC,FIBA

Dept. of Pharmacology, Faculty of Medicine, Methodist University of Indonesia-Medan

Kerusakan Pemb. Darah Tekanan Darah Kolesterol LDL Kencing Manis

S T R E S S O K S I D A T I F

N Y E R I

Peradangan
D A D A

Merokok

Dzau VJ. Hypertension 2001; 37: 1047-52 Ross, R. N Eng J Med 1999; 340: 115-126

Cumulative Incidences of Events, According to Glucose-Control Strategy

Patel A. et al. The ADVANCE collaborative Group N Engl J Med 2008; 358: 2560-72

Diabetes ? Classification of DM The Regulation and Dysregulation of Blood Glucose Clinical Features of Type I and Type DM Criteria of DM Pathophysiological Basis of the Symptoms and Signs of Diabetes Complications of DM Drugs Used in Controlling DM Evidence-based medicine on DM

A clinical syndrome characterized by hyperglycemia due to absolute or relative deficiency of insulin.

The classification of diabetes

Type 1 diabetes (results from -cell destruction, usually leading to absolute insulin deficiency) Type 2 diabetes (results from a progressive insulin secretory defect on the background of insulin resistance)

Other specific types of diabetes due to other causes, e.g., genetic defects in -cell function, genetic defects in insulin action, diseases of the exocrine pancreas (such as cystic fibrosis), and drug or chemical-induced diabetes (such as in the treatment of AIDS or after organ transplantation)
Gestational diabetes mellitus (GDM) (diabetes diagnosed during pregnancy)
American Diabetes Association 2010

Etiologic Classification of Diabetes Mellitus

Normal Glucose Metabolism

1. A1C 6.5%. OR

2. FPG 126 mg/dl (7.0 mmol/l). Fasting is defined as no caloric intake for at least 8 h. OR 3. Two-hour plasma glucose 200 mg/dl (11.1 mmol/l) during an OGTT. The test should be performed as described by the World Health Organization, using a glucose load containing the equivalent of 75 g anhydrous glucose dissolved in water. OR 4. In a patient with classic symptoms of hyperglycemia or hyperglycemic crisis, a random plasma glucose 200 mg/dl (11.1 mmol/l).
American Diabetes Association 2010

Pathophysiological Basis of the Symptoms and Signs of Diabetes

Acute : Diabetic Ketoacidosis

Chronic :

Macrovascular Disease (Coronary, Cerebral and Peripheral vascular disease) Microvascular Disease ( Diabetic microangiopathy) : Diabetic Nephropathy, Diabetic Retinopathy, Diabetic Neuropathy

Insulin Resistance Hyperinsulinemia and Atherosclerosis

Libby, P. et al. Circulation 2005;111:3481-3488

Drugs Used in Controlling Diabetes

The Characteristics of Type I and Type II DM,

Classified by National Diabetes Data Group in 1979

HLA, Human Leucocyte Antigen

Insulin

Oral Antidiabetic

Pharmacokinetic Profiles of Insulin

Hypoglycemic Drugs - Sulfonylurea drugs

- Meglitinide drugs - Rapaglinide (Prandin) - Nateglinide (Starlix)

Antiglycemic Drugs - Metformin - Thiazolidinediones - Pioglitazone (Actos) - Rosiglitazone (Avandia) -Glucosidase Inhibitors - Acarbose (Precose) , - Miglitol (Glyset)

Mechanism of Action of Oral Hypoglycemic Agents

Pharmacologic Properties of Oral Antidiabeic Drugs

Effects of Oral Antidiabetic Drugs

FPG, Fasting Plasma Glucose Concentration PPG, Postprandial glucose concentration HBA1c , Glycosylated hemoglobin conc.

Diet Exercise Drugs Education

The Role of Amyloidogenic Islet Amyloid Polypeptide in the Pathogenesis of type 2 Diabetes Mellitus

Prevalence of retinopathy by deciles of the distribution of FPG, 2hrPPG and HbAlc in 40- to 74-year-old participants in the National Health and Nutritional Epidemiologic Survey (NHANES III).

x-axis ,the lower limit of each decile group. FPG=fasting plasma glucose; 2hrPG=two-hour postprandial plasma glucose; HbA1c=glycosylated hemoglobin)

Pooled relative risk and risk difference (per 1000 patients over 5 years of treatment) estimates of severe hypoglycemia, by trial, early and more recent trial subgroups, and overall.ACCORD = Action to Control Cardiovascular Risk in Diabetes (12); ADVANCE = Action in Diabetes and Vascular Disease: Preterax and Diamicron Modified Release Controlled Evaluation (13); UKPDS = United Kingdom Prospective Diabetes Study (8, 11); VADT = Veterans Affairs Diabetes Trial (14).

Kelly T N et al. Ann Intern Med 2009;151:394-403

2009 by American College of Physicians