List of diabetes medicines
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Comprehensive Overview of Diabetes Medicines
Essential Diabetes Medicines in Low and Middle-Income Countries
Diabetes management in low and middle-income countries (LMICs) often relies on national essential medicines lists (NEMLs). A survey of 32 LMICs revealed that nearly all countries included fast-acting (97%) and intermediate-acting insulin (93%), as well as oral medications like glibenclamide and metformin (100%) as essential medicines. The median number of essential diabetes medicines was six, equally divided between insulins and oral medications. However, only 20% of these countries included insulin analogues. The study suggests that while the selection of essential medicines is generally adequate, there is room for improvement, such as replacing glibenclamide with gliclazide.
Monotherapy and Combination Therapy for Type 2 Diabetes
For type 2 diabetes, a variety of medications are available, each with different effects on glucose-lowering, safety, and other outcomes. The most common first- and second-line therapies include metformin, thiazolidinediones, sulfonylureas, DPP-4 inhibitors, SGLT-2 inhibitors, and GLP-1 receptor agonists. Recent systematic reviews have highlighted the effectiveness of these medications both as monotherapies and in combination with metformin. Newer classes like SGLT-2 inhibitors and DPP-4 inhibitors have shown promising results in terms of both efficacy and safety.
Global Variations in Essential Diabetes Medicines
A study examining 127 countries found significant variability in the listing of diabetes medicines on NEMLs. This variability impacts diabetes-related health outcomes, including mortality rates. The study underscores the importance of improving access to essential diabetes medicines to reduce diabetes-related deaths globally.
Pharmacological Prevention of Type 2 Diabetes
Several pharmacological agents have been studied for their potential to prevent or delay the onset of type 2 diabetes. Metformin, acarbose, troglitazone, and orlistat have shown efficacy in reducing diabetes incidence in randomized controlled trials. However, the long-term effectiveness of these agents in genuinely preventing diabetes, as opposed to merely delaying its onset, remains uncertain.
Natural Products and Herbal Medicines
Natural products and medicinal plants have long been used in the treatment of diabetes. Compounds such as galegine, picnogenol, acarbose, and miglitol have shown antidiabetic properties. Various plants like aloe, cinnamon, fenugreek, and bitter melon have been studied for their potential benefits in managing diabetes and its complications . These natural products work through multiple mechanisms, including inhibition of α-glucosidase and α-amylase, modulation of glucose transporters, and reduction of oxidative stress.
Recent Advances in Anti-Diabetic Drugs
Recent advancements in anti-diabetic drugs have introduced new classes of medications, including PPAR agonists, PTP1B inhibitors, aldose reductase inhibitors, and GPCR agonists. These drugs offer new mechanisms of action and have shown multi-target pharmacological effects, providing more options for personalized diabetes management.
Regulatory Approvals and New Medications
Since 2005, over 40 new medications for type 2 diabetes have been approved, including new active substances and modified insulin products. These approvals are regulated by agencies like the European Medicines Agency, which requires evidence of improved glucose control and cardiovascular safety. New medications like SGLT2 inhibitors, which work by preventing glucose reabsorption in the kidneys, represent a significant advancement in diabetes treatment.
Conclusion
The landscape of diabetes medications is diverse and continually evolving. Essential medicines like insulin and metformin remain foundational, while newer classes of drugs offer additional benefits and mechanisms of action. Improving access to these medications, especially in LMICs, and continuing to explore natural and synthetic options will be crucial in managing and preventing diabetes effectively.
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