Table 1.
List of existing anti-diabetic drugs with their mechanisms and side effects.
| S. No. | Class | Mechanism of action | Side effects | Complication/Toxicities |
|---|---|---|---|---|
| 1 | Biguanide (Metformin) | Increases the effect of insulin | Reduced vitamin B12 absorption, weight loss, lactic acidosis, diar rhea, abdominal cramps | Liver failure, chronic kidney disease |
| 2 | Sulfonylureas (glyburid e, glimepiride) | Enhances insulin secr etion from pancreatic beta-cel ls | Hemolysis, agranulo cytosis, weight gain | Obesity, cardiovascular comorbidities, allergy |
| 3 | Meglitinides (nateglinide, rep aglinide) | Increase insulin secr etion from pancreatic beta-cel ls | Weight gain, risk of hypoglycemia | Liver and renal failure |
| 4 | DPP-4 inhibitors (saxagliptin, sitagli ptin) | Inhibit glucagon-like peptide-1 degra dation and promotes glucose-de pendent insulin secretion | Pancreatitis, headache, gastrointestinal complaints, arthralgia, dizziness | Liver and renal failure |
| 5 | GLP-1 agonists (exenatide, liraglutide, albiglutide) | Direct stimulation of glucagon-like peptide-1 receptor | Pancreatitis, pancreati c cancer, nausea | Gastrointestinal motility disorders |
| 6 | SGLT-2 inhibitors (canagliflozin, dapagliflozin, empagliflozin) | Increased glucosuria by inhibiting SGLT-2 in the kidney | Urinary tract infections, polyuria, dehydration, yeast infections, diabetic ketoacidosis | Urinary tract infections, chronic kidney disease |
| 7 | Alpha-glucosidase inhibitors (acarbose) | Reduce intestinal glucose absorption | Flatulence, diarrhea | Renal failure, inflammatory bowel disease |
| 8 | Thiazolidinediones (pioglitazone) | Reduce insulin resistance through the stimulation of PPARs | Cardiac failure, weight gain, osteoporosis, edema | Liver disease, congestive heart failure |
| 9 | Amylin analogues (pramlintide) | Reduce glucagon release | Risk of hypoglycemia, nausea | Gastroparesis |
DPP-4, Dipeptidyl peptidase-4; SGLT-2, Sodium-glucose co-transporter-2; GLP-1, Glucagon-like peptide-1; PPARs, Peroxisome proliferator-activated receptors.