What are the "side effects" of commonly used oral hypoglycemic drugs?

Author: Doctor Renxin This article is published by Yimaitong authorized by the author, please do not reprint without permission.

Introduction: Any drug has side effects, and oral hypoglycemic drugs are no exception.
Although in general, the benefits of hypoglycemic drugs outweigh the risks, there are still some patients who have obvious adverse reactions to certain drugs.

Commonly used oral hypoglycemic agents in clinical practice include insulin secretagogues (sulfonylureas and glinides), biguanides (metformin), α-glycosidase inhibitors, thiazolidinediones and dipeptidyl peptidase-4 ( DPP-4) inhibitors, sodium-glucose cotransporter-2 (SGLT-2) inhibitors, etc.
What are the side effects of these oral hypoglycemic drugs and how to deal with them? Medication helps.

Insulin secretagogues (sulfonylureas and glinides).
Sulfonylureas and glinides are insulin secretagogues.
They play a hypoglycemic effect by stimulating pancreatic β-cells to secrete insulin.
Therefore, these drugs are mainly suitable for Patients with type 2 diabetes who retain part of the islet function.

1.
Side effects Common side effects are weight gain and hypoglycemia.

The mechanism of weight gain caused by this class of drugs includes insulin assimilation of the drug (promoting the synthesis of fat, protein and glycogen; causing hunger and increased calorie intake) and fluid retention.

The results of the study show that sulfonylurea drugs increase the average weight of patients by about 1.
7kg; hypoglycemia is mainly related to overdose and the use of powerful sulfonylurea hypoglycemic agents (mainly glibenclamide).

Glinides belong to meal blood glucose regulators with short action time and generally do not cause hypoglycemia.

2.
Preventive measures (1) For obese patients, avoid the first choice of drug therapy (but not contraindications).

In clinical treatment, the use of diuretics can reduce water and sodium retention, strengthening diet control and increasing exercise can help reduce weight gain.

Combined with biguanides and α-glycosidase inhibitors can reduce body weight.

(2) The main factors that increase the occurrence of hypoglycemia events of sulfonylureas include: advanced age, alcohol consumption, liver and kidney diseases, drug overdose, drug interactions, etc.
, the mechanism of action and dosage forms of different sulfonylureas are different, and their low The incidence of blood sugar is also different, among which glibenclamide has the highest risk of causing hypoglycemia.

Measures to prevent hypoglycemia of sulfonylureas include: ➤ Elderly and frail patients are recommended to choose gliclazide sustained-release tablets, glimepiride, or other short-acting preparations that have a relatively low risk of hypoglycemia; ➤should start with a small dose Start taking, and slowly increase the amount to the optimal dose according to the results of blood glucose monitoring; ➤In terms of diet, you should take a fixed amount of food and avoid strenuous exercise before meals.

If symptoms such as diarrhea and vomiting occur, the dose of the drug should be reduced.

Biguanides (metformin) 1.
Side effects The main side effects of metformin are gastrointestinal reactions and lactic acidosis.

Among them, the incidence of gastrointestinal reactions is 5%-20%; lactic acidosis is the most serious adverse reaction of biguanides.
For the widely used metformin, the incidence of lactic acidosis is very low, but once it occurs, the consequences are serious.

2.
Preventive measures (1) Biguanide drugs are best taken during or after meals, and start with small doses and gradually increase the dosage, so that patients can gradually tolerate them, and can effectively reduce the patient's digestive tract reaction .

(2) In order to prevent lactic acidosis, metformin is forbidden for patients with renal insufficiency, liver dysfunction, and cardiopulmonary insufficiency.

Metformin should also not be used in patients who have undergone surgical treatment and the application of iodine contrast agents for 2 days before and after the examination.

Alpha-Glycosidase Inhibitors 1.
Side Effects Alpha-Glycosidase Inhibitors can cause adverse reactions such as flatulence and hyperintestinal sounds, including peculiar smell, nausea, anorexia, bloating, abdominal pain, diarrhea, farting, etc.
, which often appear in the early stage When taking medicine or taking medicine on an empty stomach.

Hypoglycemia may occur when combined with other hypoglycemic drugs (such as insulin, sulfonylureas or metformin).

2.
Preventive measures (1) Generally speaking, the adaptation and tolerance of the gastrointestinal tract to drugs requires a process.

When using such drugs, you must start with a small dose and gradually increase to the therapeutic dose after 1-2 weeks, which can alleviate gastrointestinal reactions.

(2) This medicine makes the decomposition of sucrose into fructose and glucose more slowly.
Therefore, if acute hypoglycemia occurs, glucose should be used directly to correct the hypoglycemic reaction.

Thiazolidinediones 1.
Side effects Thiazolidinediones are insulin sensitizers that improve insulin resistance by increasing the sensitivity of insulin to surrounding tissues and organs.

A small number of people can cause water and sodium retention after taking it, causing swelling of the face and lower limbs, and aggravating heart failure.

In addition, such drugs may also cause abnormal liver function and osteoporosis.

For example, troglitazone, which was marketed early, has been banned because it can cause severe liver damage and liver damage; previous studies have also shown that rosiglitazone can increase the risk of myocardial infarction and cardiovascular death in diabetic patients.

Pioglitazone may increase the risk of bladder cancer and the incidence of fractures in female patients.

2.
Prevention methods thiazolidinedione drugs are prohibited for those with elevated serum transaminase (alanine aminotransferase greater than 2.
5 times the upper limit of normal).

Weigh the pros and cons before medication.
Patients with bladder cancer or patients with a history of bladder cancer and patients with a history of osteoporosis should avoid pioglitazone.

Patients with edema should be cautious in using these drugs.
In addition, they should be alert to the adverse effects of rosiglitazone in the cardiovascular system.
It is recommended to strictly regulate their clinical use.

Dipeptidyl peptidase-4 (DPP-4) inhibitor 1.
Side effects DPP-4 inhibitor is a new type of hypoglycemic agent, which can effectively reduce incretin GLP-1 (glucagon-like) by inhibiting the activity of DPP-4 The inactivation of polypeptide-1) increases the level of active GLP-1 in the physiological range, which can promote the secretion of insulin by pancreatic β cells to play a hypoglycemic effect.

Hypoglycemia may occur, but compared with other oral hypoglycemic drugs, the chance of hypoglycemia is small.

The main adverse reactions include nasopharyngitis, headache, upper respiratory tract infection, etc.
The gastrointestinal reaction is mild, and other rare adverse reactions include angioedema, hypersensitivity, elevated liver enzymes, diarrhea, cough, lymphocyte absolute Count down, etc.

2.
The prevention method is generally well tolerated and does not require special treatment.
In severe cases, stop the drug and treat the symptoms symptomatically. Sodium-glucose cotransporter-2 (SGLT-2) inhibitors 1.
Side effects SGLT-2 inhibitors mainly act on SGLT-2 in the proximal convoluted tubules of the kidney, inhibiting its reabsorption of glucose, increasing urinary glucose excretion and lowering blood sugar Level.

The main side effects are: (1) Urogenital tract infection: The local glucose concentration in the urogenital tract increases the chance of bacterial and fungal infections.

Vaginal candidiasis, vulvovaginitis, etc.
are more common in women, and candidal balanitis and phallic dermatitis are more common in men.
The infection rate is higher in patients with a history of infectious diseases.

(2) Hypoglycemia: When SGLT-2 inhibitors are only used in combination with insulin or sulfonylureas, the risk of hypoglycemia increases.

(3) Diabetic ketoacidosis (DKA): It is very rare.
Most SGLT-2 inhibitor-related DKA cases occur in insulin-deficient diabetic patients.
The predisposing factors are surgery, excessive exercise, myocardial infarction, and very low carbohydrates.
Ingestion and other stress events, and some patients with insulin combined with insulin lose too much insulin.

(4) Hypovolemia/hypotension: As SGLT-2 inhibitors increase the excretion of sodium from the urine and the excretion of sugar in the urine increases, the urine output will also increase, followed by a decrease in volume, including low Blood volume and hypotension, but the incidence is low.

(5) Low-density lipoprotein cholesterol (LDL-C) is elevated.

2.
Prevention methods (1) Ask the medical history before taking the medicine.
It is not recommended for patients who have repeated genitourinary infections within half a year.

During the treatment process, especially in the first month of treatment, it is necessary to pay attention to the possibility of urinary and reproductive tract infections.
If infection occurs, anti-infective treatment is required.
At the same time, SGLT-2 inhibitors are suspended and the infection is cured.

Instruct patients to pay attention to personal genital hygiene, drink moderate amounts of water, and maintain unobstructed urination.

(2) When combined with insulin or sulfonylureas, pay attention to adjusting the dosage of insulin or sulfonylureas to prevent hypoglycemia.

(3) In order to reduce the risk of DKA, it is recommended to stop SGLT-2 inhibitors 24 hours before elective surgery or strenuous physical activity.

Patients diagnosed with DKA should immediately stop SGLT-2 inhibitors and treat them symptomatically.

(4) Before medication, assess the patient's blood volume status.

Patients with hypovolemia should start treatment after the blood volume is corrected, and monitor symptoms and signs after treatment.

(5) Monitor blood lipids as needed, and combine lipid-lowering therapy if necessary for abnormal dyslipidemia.

Concluding remarks So far, diabetes has not been completely cured, which means that once they get sick, patients need long-term or even life-long medication.

Objectively speaking, as long as all drugs have duality, they have both positive therapeutic effects and certain side effects.
There is no absolutely safe drug.

Only by understanding the side effects of drugs can we weigh the pros and cons in the clinic, choose carefully, know ourselves and the enemy, and use drugs rationally to ensure safety and effectiveness.

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Progress in the study of adverse reactions of oral hypoglycemic drugs[J].
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[2]Lüqian,Shi Yongquan.
Effects of sulfonylureas on body weight And precautions for clinical application[J].
Drug Evaluation,2017,14(03):32-35.
[3]The reasonable clinical application of sodium-glucose cotransporter 2 inhibitors recommended by Chinese experts[J].
Chinese Journal of Diabetes,2016 (24): 865-870.
[4] "Expert Consensus on the Clinical Application of Metformin (2016 Edition)".
Chinese Journal of Diabetes.
2016, 24(10): 871-884.