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Allopathic Medicines
Published in Varma H. Rambaran, Nalini K. Singh, Alternative Medicines for Diabetes Management, 2023
Varma H. Rambaran, Nalini K. Singh
Repaglinide was the first of the two meglitinides that were developed and used in adults with type-2 diabetes mellitus (T2DM) (Rosenstock et al. 2004). Like repaglinide, nateglinide also binds competitively to the sulfonylureas' receptor however, the pharmacodynamic properties of this molecule are unique in several aspects. Firstly, in vitro studies have indicated that nateglinide inhibits the potassium ATP channels faster than repaglinide and within a shorter duration of action (Guardado-Mendoza et al. 2013)., and the half-life of nateglinide on the SUR-1 receptor is approximately 5 seconds compared to that of repaglinide, which is approximately 3 minutes.
Carbohydrate metabolism
Published in Martin Andrew Crook, Clinical Biochemistry & Metabolic Medicine, 2013
Other oral agents are the thiazolidinediones or ‘glitazones’, for example rosiglitazone and pioglitazone, which activate g-peroxisome proliferator-activated receptors and which can reduce insulin resistance by a number of metabolic pathways, some of which involve increasing the transcription of nuclear proteins that control free fatty acid and tissue glucose uptake. Repaglinide is a meglitinide that increases insulin release from pancreatic β-cells and enhances tissue insulin sensitivity. The incretins are gastrointestinal hormones that increase insulin release from the pancreas after eating, for example glucagon-like peptide (GLP-1) and gastric inhibitory peptide (GIP). They are rapidly inactivated by the enzyme dipeptidyl peptidase-4 (DPP-4). Incretin mimetics such as exenatide or liraglutide or DPP-4 inhibitors such as sitagliptin, vildagliptin or saxagliptin are being used in type 2 diabetes mellitus..
Medical Nutrition Therapy for Patients with Type-2 Diabetes
Published in Jeffrey I. Mechanick, Elise M. Brett, Nutritional Strategies for the Diabetic & Prediabetic Patient, 2006
Bantwal Suresh Baliga, Zachary Bloomgarden, Cathy Nonas
A common misconception among patients with T2DM and their families is that they must eat at specified times throughout the day to avoid hypoglycemia. In the past, this was true as patients were treated primarily with sulfonylureas and neutral pH–protamine–Hagedorn insulin (NPH). However, with modern-day diabetes management, more flexible eating patterns are possible depending on the treatment regimen. Sulfonylureas act for up to 24 hours and a patient taking one of these medications must have regular carbohydrate-containing meals to avoid hypoglycemia. The shorter-acting meglitinides can be taken only at mealtimes and meals can be skipped. In addition, repaglinide doses can be adjusted for variability in carbohydrate intake from meal to meal, or day to day. Patients taking only an insulin sensitizer, metformin, or a thiazolidinedione are not at risk for hypoglycemia if a meal is missed, as these medications do not stimulate insulin secretion. Likewise, the α-glucosidase inhibitors do not pose any risk of hypoglycemia and are only taken with a carbohydrate-containing meal.
Bilosomes as a promising nanoplatform for oral delivery of an alkaloid nutraceutical: improved pharmacokinetic profile and snowballed hypoglycemic effect in diabetic rats
Published in Drug Delivery, 2022
Mohammed H. Elkomy, Hussein M. Eid, Mohammed Elmowafy, Khaled Shalaby, Ameeduzzafar Zafar, Mohamed A. Abdelgawad, Mostafa E. Rateb, Mohammed R.A. Ali, Izzeddin Alsalahat, Heba A. Abou-Taleb
Diabetes mellitus (DM) prevalence increases due to poor nutrition and lifestyle behaviors, imposing a significant burden on individual families and societies (Karthikeyan et al., 2014). Currently, DM is generally treated with insulin injections and oral antidiabetic medications. However, subcutaneous insulin injections are painful and are sometimes linked with an allergic response, lipodystrophy, hypoglycemia, and even hyperinsulinemia (Wong et al., 2016). Similarly, oral antidiabetic medications such as glipizide, metformin, and repaglinide have gastrointestinal side effects, a significant risk of hypoglycemia, and weight gain (Arai et al., 2016). While these therapeutic approaches may improve some of the symptoms associated with DM, they cannot cure the disease completely. New effective drugs for DM treatment are still essential.
Acute and chronic non-pulmonary complications in adults with cystic fibrosis
Published in Expert Review of Respiratory Medicine, 2019
Lucile Regard, Clémence Martin, Guillaume Chassagnon, Pierre-Régis Burgel
Treatment of CFRD relies on insulin therapy. Though oral treatment is not recommended in patients with CFRD [22], a single study suggested that repaglinide could be effective in some patients [97]. These results need to be confirmed in long-term studies and with a larger population sample, however. High-calorie food intake must be maintained [92] and physical activity should be promoted. Because their life expectancy is increasing, adults with CF become more likely to develop complications of CFRD. Microvascular complications comparable to those seen in patients with type 1 diabetes (neuropathy, retinopathy, and nephropathy) have been reported in patients with CFRD, especially in the context of poor glycemic control [98–101]. Thus, screening for retinopathy (dilated eye examination), neuropathy (clinical evaluation), and nephropathy (microalbuminuria screening) should be performed at least annually and foot issues should be closely monitored [22,88]. Macrovascular complications have so far been rare and only a few cases of coronary disease have been reported in patients with CFRD [102,103]. However, it seems likely that these complications will become more frequent in the future because of long-standing diabetes in aging CF adults.
Glycemic control of type 2 diabetes mellitus across stages of renal impairment: information for primary care providers
Published in Postgraduate Medicine, 2018
Meglitinides are metabolized primarily in the liver with little renal clearance of active product, consistent with data demonstrating minimal effects of renal impairment on PK. Although prescribing information for nateglinide indicates no dose adjustments across the stages of CKD [36], caution is advised in patients with an eGFR of less than 30 mL/min/1.73 m2, as hypoglycemia can occur due to an accumulation of active metabolites [37]. Repaglinide has also been associated with an increased half-life after repeated dosing in patients with severe renal impairment, and therefore careful dose titration of repaglinide is recommended in advanced stages of CKD [38,39].