Antidiabetics

Antidiabetics are medicines used to manage diabetes mellitus, a disorder of chronic hyperglycemia resulting from insufficient insulin action. They aim to control blood glucose, reduce complications, and improve quality of life. Treatments are tailored to diabetes type, patient factors, and comorbidities, and may include lifestyle changes alongside pharmacotherapy.

Insulin replaces or substitutes endogenous insulin and is essential for type 1 diabetes; many regimens exist, including rapid-acting, short-acting, intermediate-acting, and long-acting analogs. Insulin is administered by subcutaneous injection or infusion. Common risks include hypoglycemia and weight gain; monitoring requires regular glucose checks and dose adjustments based on meals and activity.

Non-insulin agents include metformin (a biguanide), which lowers hepatic glucose production and improves insulin sensitivity; it is commonly first-line in type 2 diabetes. Other classes—sulfonylureas and meglitinides, thiazolidinediones, incretin-based therapies (DPP-4 inhibitors and GLP-1 receptor agonists), SGLT2 inhibitors, and alpha-glucosidase inhibitors—have distinct mechanisms and safety profiles and are chosen based on patient goals and comorbidities.

Therapy is individualized; metformin is often started first in type 2 diabetes, with other oral agents or insulin added as needed to achieve glycemic targets such as an HbA1c near 7%. Safety monitoring includes kidney and liver function, risk of hypoglycemia, and potential drug interactions.

In clinical practice, antidiabetics form part of a comprehensive strategy that includes diet, physical activity, education, and regular monitoring to control hyperglycemia and reduce diabetes-related complications.