Precautions that these 7 groups of people need to know when using hypoglycemic drugs

*Only for medical professionals to refer to the use of hypoglycemic drugs in different populations, how should I choose? For some special populations, such as the elderly, pregnant women, children, patients with hepatic insufficiency, patients with renal insufficiency, obese patients, and patients with three highs, it is necessary to select appropriate hypoglycemic drugs according to the characteristics of the patient's disease.

How to choose hypoglycemic drugs in different groups of people? 1 In choosing hypoglycemic drugs for the elderly, one is to avoid hypoglycemia and choose hypoglycemic drugs with a lower risk of hypoglycemia.
The first-line recommended drugs are metformin, DPP-4 inhibitors, and SGLT-2 inhibitors, and the second is There are many types of medications used by the elderly, and multi-drug combination often has the phenomenon of reduced efficacy or increased side effects.

When choosing hypoglycemic drugs, special attention should be paid to drug interactions.

If metformin is used in combination with an iodine contrast agent, it may cause contrast-medium nephropathy, cause metformin to accumulate, and increase the risk of lactic acidosis.
It is necessary to determine the timing of discontinuation based on renal function.

Combined use of metformin and vitamin B12 can affect the absorption of vitamin B12 and cause megaloblastic anemia.
It is recommended to check serum vitamin B12 every 2-3 years.

The combination of acarbose and warfarin can enhance the anticoagulant effect of warfarin and increase the risk of bleeding.
The combination of the two needs to monitor the INR value and adjust the warfarin dose.

Sulfonylureas metabolized by CYP2C9 enzymes (glibenclamide, glimepiride, gliclazide, glipizide), Glines metabolized by CYP3A4 enzymes (repaglinide, nateglinide), CYP3A4 /5 DDP-4 inhibitor (Saxagliptin) metabolized by enzyme, thiazolidinediones (rosiglitazone, pioglitazone) metabolized by CYP2C8, SGLT-2 inhibitor metabolized by UGT1A9 enzyme (Kag Liejing), etc.
, in combination with the corresponding liver drug enzyme inducer or inhibitor, which affects the efficacy.
If combined, the dose of hypoglycemic drugs needs to be increased or decreased.

2 In order to ensure the safety of the fetus during pregnancy, the hypoglycemic drugs that can be used safely include all human insulin (short-acting, medium-acting and premixed human insulin), insulin analogues (insulin aspart, insulin lispro, Detemir).

Except for metformin, other oral hypoglycemic drugs are not recommended for use in pregnancy.

There is no indication for the use of metformin during pregnancy in my country.
It needs to be used with informed consent.
It is not recommended to use metformin alone during pregnancy, and it needs to be used in combination on the basis of insulin.

 3 Children's hypoglycemic drugs should be used in children to choose hypoglycemic drugs that are safe within the age range.

Among them, the oral hypoglycemic agent only metformin can be used for children ≥ 10 years old.

In insulin preparations, insulin can be used for children, but there are different age ranges.
Insulin aspart can be used for children over 2 years old, and insulin glargine and insulin detemir can be used for children over 6 years old.

 4 Patients with hepatic insufficiency currently commonly used hypoglycemic drugs in clinical practice can basically be used for patients with mild to moderate hepatic insufficiency.
In patients with severe hepatic insufficiency, insulin preparations are preferred, and oral hypoglycemic drugs are preferred to have little effect on liver function, linagliptin , Lisnatide and other hypoglycemic drugs.

5 In patients with renal insufficiency, when GFR≥60[ml•min-1•(1.
73 m2)-1], commonly used clinically used hypoglycemic drugs can be used normally; GFR＜60[ml•min-1•(1.
73 m2)-1] ] When most hypoglycemic drugs need to be reduced or banned, you can choose hypoglycemic drugs used in normal doses throughout the course, including insulin preparations or oral hypoglycemic drugs such as rosiglitazone and linagliptin.

 6 Antidiabetic drugs that can reduce body weight in obese patients include GLP-1 receptor agonists, SGLT-2 inhibitors, metformin, α-glycosidase inhibitors, and weight-neutral antidiabetic drugs include DPP-4 inhibitors.
Antidiabetic drugs that increase weight include sulfonylureas, glinides, thiazolidinediones, and insulin preparations.

Obese diabetic patients prefer hypoglycemic drugs that can reduce body weight.

 7 Three-high patients Diabetic patients often have high blood pressure or hyperlipidemia, forming three-high patients.

Patients with diabetes mellitus and hypertension preferentially choose hypoglycemic drugs that have the effect of lowering blood pressure, such as biguanides, GLP-1 receptor agonists, SGLT-2 inhibitors, and thiazolidinediones.

Patients with diabetes mellitus and hyperlipidemia preferentially choose hypoglycemic drugs that have the effect of lowering blood lipids, such as biguanides, GLP-1 receptor agonists, and SGLT-2 inhibitors.

 References: [1] Diabetes Branch of Chinese Medical Association.
Guidelines for Prevention and Treatment of Type 2 Diabetes in China (2020 Edition [J].
Chinese Journal of Diabetes, 2021.
13(4):315-409.
[2] National Center for Geriatrics, etc.
.
Guidelines for Diagnosis and Treatment of Diabetes in the Elderly in China (2021 Edition)[J].
Chinese Journal of Diabetes, 2021,13(1):14-46.
[3] Instructions for various hypoglycemic drugs.