www.diabeticretinopathy.org.uk

General

Less  common drugs for type 2 diabetes glucose control

 

David Kinshuck,

 

 

Meglitinides

Meglitinides help the pancreas make more insulin. An example of a meglitinide is repaglinide (Prandin). Another example is nateglinide (starlix). This causes negligible weight gain and very few hypos.

Take these tablets 30 minutes before meals. If you forget a dose, do not double the next dose. Also, if you take a tablet but do not eat, there won't be any problems. It is recommended to be used in addition to metformin if metformin does not cause the required drop in sugar levels, (or an HbA1c above 6.5%).

 

Amaryl

Glimepiride (amaryl) works primarily by increasing insulin secretion, and is used once a day. The most common side effects include dizziness, asthenia, headache, nausea, and hypos.

 

Xenical

"XENICAL is an oral prescription weight-loss medication used to help considerably overweight people lose weight and keep this weight off. XENICAL works in your digestive system, where it blocks about one-third of the fat in the food you eat from being digested. This undigested fat in the food you eat is then eliminated in your bowel movements. XENICAL should be used together with a reduced-calorie diet with no more than 30% of calories from fat, which your doctor will recommend."

Xenical is sometimes used in the UK as part of treatment of being overweight in diabetes, as recent research suggests it may be helpful. It can be safely used in diabetes, whether or not your diabetes is diet controlled, you use tablets, or insulin. By helping you lose weight it can lower your sugar levels and blood pressure. It can be used with most types of medication (but not cyclosporin), with no interactions.
Ideally you need to lose weight (2.5kg) in the 4 weeks before you start. You should lose 5% of your weight at 3 months, and 16% at 12 months. Visit Xenical.

 

Glitazones

Glitazones may increase macular oedema.   Local experts recommend these drugs are not used if retinopathy has developed.  Macular oedema.

Examples are pioglitazone. Like metformin, glitazones make the cells in your body more sensitive to your own natural insulin.
Glitazones are approved for type II diabetes patients who are not taking insulin. The possible side effects include anaemia, an increase in cholesterol, fluid retention, and gain in weight from the fluid. Talk to your doctor about lowering the dose of your sulfonylurea. It does not matter what time of day these are taken. See for more details http://www.avandia.com

Pioglitazone is another glitazone. In the Proactive study, it lowered HbA1c  0.5%. However, it caused weight gain with +3.6kg extra fluid. The fluid causes 1% more heart failure. In UK we cannot use with insulin, and it takes 4 weeks to work.
However, it may be very useful for for insulin resistant patients as it can dramatically reduce insulin requirement (even 50% less). Glitazones contribute to osteoporosis, so are be avoided in post-menopausal women or anyone else at risk. They can also lead to more heart problems.

The BMJ 09 reviews glitazones but the article ignores retinopathy.