Chapter 35: Drugs for the Treatment of Diabetes

Drugs for the Treatment of Diabetes overview delves into the pharmacological landscape of diabetes mellitus, a chronic metabolic condition defined by inadequate insulin secretion or action. The chapter highlights the critical functions of the endocrine pancreas, specifically the interplay between insulin, which facilitates glucose storage and utilization, and glucagon, which raises blood sugar levels. It details the physiological differences between Type 1 diabetes, marked by autoimmune destruction of insulin-producing beta cells, and Type 2 diabetes, which is primarily driven by insulin resistance and lifestyle factors. Students will explore the diverse range of insulin therapies, classified by their pharmacokinetic profiles into rapid, short, intermediate, and long-acting preparations, including modern recombinant analogs and inhaled options. The discussion extends to a wide array of non-insulin medications, such as biguanides like metformin—the first-line treatment for its weight-neutral and sensitizing effects—and secretagogues like sulfonylureas and meglitinides that trigger insulin release. Advanced therapeutic categories are also analyzed, including thiazolidinediones that target nuclear receptors, incretin-based therapies like GLP-1 receptor agonists and DPP-4 inhibitors that regulate appetite and gastric motility, and SGLT2 inhibitors that modulate renal glucose reabsorption. Furthermore, the chapter covers adjunct treatments like alpha-glucosidase inhibitors and amylin analogs, while providing clinical guidelines for long-term glycemic management using the A1c biomarker and the urgent treatment protocols for diabetic ketoacidosis.