Table 3.
Treatment modalities of type 2 diabetes
| Cardio-metabolic abnormalities | Drugs | Mode of action |
|---|---|---|
| Hyperglycemia Insulin resistance | Biguanides | Increases liver and muscle insulin sensitivity; decreases hepatic glucose production |
| Sulphonylureas | Insulin secretogogues | |
| Alpha-glucosidase inhibitors | Delay the absorption of polysaccharides and also act to attenuate postprandial glucose excursions | |
| Sulphonylurea-like agents | Insulin secretogogues | |
| Thiazolidinediones | Insulin sensitizers that improve glucose uptake in adipose tissues and skeletal muscles | |
| Insulin | Reduces hepatic glucose output and increases peripheral glucose utilization | |
| Hypertension | ACE inhibitors | Block the formation of AT-II, increase bradykinin level. As a result reduce vasoconstriction, reduce sodium and water retension, and increase vasodilation (through bradykinin). |
| Angiotensin receptor blockers Losartan and valsartan | Competitive inhibition of AT-II receptor (Type 1). Effect more specific on AT-II action, less or none on bradykinin production or metabolism. | |
| Beta blockers | Inhibit renin release and AT-II and aldosterone production and lower peripheral resistance; may decrease adrenergic outflow from the CNS. | |
| Calcium channel blockers | Dilate peripheral arterioles and thereby reduce BP by inhibiting calcium influx into arterial SM cells. | |
| Diuretics | Lower BP by depleting body sodium stores resulting in reduction of total blood volume and cardiac output; initially peripheral vascular resistance increases but declines when CO returns to normal level (6-8 weeks) | |
| Dyslipidemia | Statins | Increase lipid profile and decrease atherogenic tendency. Lower LDL-C, improve TC:HDL-C, lower apo B. |
| Fibric acid derivatives | Increase lipid profile and decrease atherogenic tendency. Lower TGs, raise HDL-C, lower TC:HDL-C and shift LDL from smaller to larger particles. | |
| Platelet activation and | Aspirin | Antiplatelet effect |
| aggregation | Clopidogrel | Irreversible blockade of the adenosine diphosphate (ADP) receptor on platelet cell membranes |
| Ticlopidine | Interferes with platelet membrane function |