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Gestational Diabetes Anti Diabetic Medication

Oral Antidiabetic Drugs In Pregnancy: The Other Alternative

Oral Antidiabetic Drugs In Pregnancy: The Other Alternative

The use of oral antidiabetic drugs in pregnancy is an accepted treatment modality for women with gestational diabetes mellitus (GDM). This efficacious option provides physicians more choices that, in turn, translate into more complex decision making for the management of GDM. However, regardless of the mode of therapy, whole patient care (glucose monitoring, education, diet adherence, and so forth) will determine overall success in managing this disease and the potential to maximize the quality of perinatal outcome. In the United States, depending on the diagnosis criteria used, 135,000–200,000 women annually develop gestational diabetes mellitus (GDM), adding to the number of pregnant women who already have either type 1 or type 2 diabetes. There has also been a significant increase (∼ 33%) in the incidence of type 2 diabetes with its presumed parallel risk for obesity1 in addition to the development of adolescent obesity in the offspring of diabetic women.2 Two main factors have contributed to the dramatic increase in pharmacological therapy: recognition that GDM is an early stage in the development of type 2 diabetes and increased awareness of the impact of the metabolic syndrome on public health and its appearance in 20–50% of women who have had GDM. This article outlines the management approach (intensified treatment) and describes the use of oral antidiabetic agents (mainly glyburide) to prevent glycemic extremes (i.e., hypoglycemia and hyperglycemia) in pregnant women with GDM and type 2 diabetes. Fundamental Structure of Intensified Therapy Intensified therapy is an approach to achieving established levels of glycemic control. Two breakthrough studies in nonpregnant diabetic patients demonstrated the effectiveness of intensified therapy: the Diabetes Contr Continue reading >>

Type 2 Oral Diabetes Medications Side Effects, Differences, And Effectiveness

Type 2 Oral Diabetes Medications Side Effects, Differences, And Effectiveness

What are the types of oral diabetes medications? Currently, there are nine drug classes of oral diabetes medications approved for the treatment of type 2 diabetes. α-glucosidase inhibitors Biguanides Sulfonylureas Meglitinides Thiazolidinediones DPP-4 inhibitors Sodium-glucose cotransporter (SGLT)-2 inhibitors These medications differ in the way they function in the body to reduce blood glucose. Metformin (Glucophage) is the only biguanide available in the United States and is generally the first choice for oral treatment of type 2 diabetes mellitus. Metformin improves Sulfonylureas are the oldest classes of oral diabetes medications. Sulfonylureas work primarily by stimulating the release of insulin. Insulin is the hormone responsible for regulating blood glucose by increasing the uptake of blood glucose by tissues and increasing storage of glucose in the liver. Meglitinides and sulfonylureas have a similar mechanism of action. Meglitinides are short acting glucose lowering medications. They stimulate the secretion of insulin from the pancreas. Thiazolidinediones enhance insulin sensitivity meaning that the effect of a given amount of insulin is greater. Thiazolidinediones also are referred to as peroxisome proliferator-activated receptor ? or PPAR-? agonists. α-glucosidase inhibitors delay the digestion and absorption of starch or carbohydrates by inhibiting enzymes in the small intestine which help breakdown these molecules. The starches and carbohydrates are broken down into glucose, which then is absorbed from the intestine and increases the level in the blood. DPP-4 inhibitors help lower blood glucose by increasing the production of insulin from the pancreas and reducing the release of glucose from the liver. SGLT2 inhibitors or sodium-glucose cotransporter 2 in Continue reading >>

What Anti-diabetic Drugs Are Safe And Effective In Treating Gestational Diabetes?

What Anti-diabetic Drugs Are Safe And Effective In Treating Gestational Diabetes?

This study investigated the safety and effectiveness of different drugs used to treat gestational diabetes. They found that metformin (Glucophage)is associated with fewer pregnancy complications than glyburide (Glynase), however it is less effective at managing blood sugar levels. Gestational diabetes (GDM) is a condition where pregnant women develop glucose intolerance, leading to elevated blood glucose during the pregnancy. This can have negative effects on both the mother and child. In order to manage GDM, most women are advised to alter their diet or increase exercise. For some patients diet and exercise do not effectively manage blood glucose level. Medications may be required. The safety and effectiveness of anti-diabetic drugs in pregnant women has been studied, however in many cases these studies investigated one or compared two treatments. This study reviewed data from clinical trials, comparing all treatments and ranking the medications based on effectiveness and adverse outcomes in GDM. This study included data from 32 clinical trials. Maternal outcomes of interest included blood glucose control, weight gain and pre-eclampsia. Neonatal (infant) outcomes included large birth weight, hypoglycemia and jaundice. Anti-diabetic drugs were then ranked based on the effectiveness and adverse outcomes. Metformin was associated with fewer negative neonatal outcomes compared to insulin or glyburide. Glyburide has a greater rate of glucose control but is associated with more adverse outcomes for both mother and child. These included pre-eclampsia, jaundice, and higher birth weight. This study concluded that metformin is associated with fewer adverse outcomes than glyburide, however it is less effective at managing blood sugar levels. There are other factors which may inf Continue reading >>

Medication For Type 2 Diabetes

Medication For Type 2 Diabetes

People with type 2 diabetes are often given medications including insulin to help control their blood glucose levels. Most of these medications are in the form of tablets, but some are given by injection. Tablets or injections are intended to be used in conjunction with healthy eating and regular physical activity, not as a substitute. Diabetes tablets are not an oral form of insulin.Speak with your doctor or pharmacist if you experience any problems. An alternative medication is usually available. All people with diabetes need to check their glucose levels on a regular basis. When taking medication, you may need to check your glucose levels more often to keep you safe and to ensure the medication is having the desired effect. In Australia there are seven classes of medicines used to treat type 2 diabetes: Biguanides Sulphonylureas Thiazolidinediones (Glitazones) Alpha-glucosidase Inhibitors. Dipeptidyl peptidase 4 (DPP4) inhibitors Incretin mimetics Sodium-glucose transporter (SGLT2) inhibitors Your doctor will talk to you about which tablets are right for you, when to take your tablets and how much to take. Your doctor can also tell you about any possible side effects. You should speak to your doctor or pharmacist if you experience any problems. Chemical name: METFORMIN , METFORMIN ER Points to remember about biguanides This group of insulin tablets helps to lower blood glucose levels by reducing the amount of stored glucose released by the liver, slowing the absorption of glucose from the intestine, and helping the body to become more sensitive to insulin so that your own insulin works better They need to be started at a low dose and increased slowly Metformin is often prescribed as the first diabetes tablet for people with type 2 diabetes who are overweight. It gene Continue reading >>

Anti-diabetic Medication

Anti-diabetic Medication

Instructions for use Oral hypoglycemic agents are successful in people only for noninsulin-dependent diabetes. There has been only limited use in animals. Because response to oral hypoglycemic agents in cats is unpredictable, it is recommended to use a trial first of at least 4 weeks. If the cat responds, the drug can be continued; otherwise, insulin may be indicated. Feed cats a high-fiber diet when using oral hypoglycemic agents. Transdermal glipizide (5-mg dose) in a PLO gel was evaluated in cats. Although the transdermal formulation produced a modest change in glucose concentrations, systemic absorption was only 20%. Oral Hypoglycemic Therapy Oral hypoglycemic agents are used in cats only to attenuate the physiologic abnormalities of type 2 diabetes by decreasing hepatic glucose output and glucose absorption from the intestine, increasing peripheral insulin sensitivity, and increasing insulin secretion from the pancreas. In cats, the clinician must rely on the response to oral hypoglycemic agents as a guide to whether the cat has sufficient β-cell function to be managed with oral hypoglycemic agents. Oral hypoglycemic agents used in cats include the sulfonylureas (glipizide) and α-glucosidase inhibitors (acarbose).16,18 Indications for oral hypoglycemic therapy in cats include normal or increased body weight, lack of ketones, probable type 2 diabetes with no underlying disease (pancreatitis, pancreatic tumor), history of diabetogenic medications, and owners' willingness to administer oral medication rather than an injection. Diet should consist of low-carbohydrate/high-protein foods only. The mechanism of action of the sulfonylureas is to increase insulin secretion and improve insulin resistance. Sulfonylureas, because of provocation of insulin release, may promot Continue reading >>

Common Drugs And Medications To Treat Diabetes During Pregnancy

Common Drugs And Medications To Treat Diabetes During Pregnancy

IMPORTANT: About This Section and Other User-Generated Content on WebMD The opinions expressed in WebMD User-generated content areas like communities, reviews, ratings, or blogs are solely those of the User, who may or may not have medical or scientific training. These opinions do not represent the opinions of WebMD. User-generated content areas are not reviewed by a WebMD physician or any member of the WebMD editorial staff for accuracy, balance, objectivity, or any other reason except for compliance with our Terms and Conditions. Some of these opinions may contain information about treatment or uses of drug products that have not been approved by the U.S. Food and Drug Administration. WebMD does not endorse any specific product, service, or treatment. Do not consider WebMD User-generated content as medical advice. Never delay or disregard seeking professional medical advice from your doctor or other qualified healthcare provider because of something you have read on WebMD. You should always speak with your doctor before you start, stop, or change any prescribed part of your care plan or treatment. WebMD understands that reading individual, real-life experiences can be a helpful resource but it is never a substitute for professional medical advice, diagnosis, or treatment from a qualified health care provider. If you think you may have a medical emergency, call your doctor or dial 911 immediately. Continue reading >>

Gestational Diabetes Treatment

Gestational Diabetes Treatment

Like type 2 diabetes, gestational diabetes develops when liver, muscle, and fat cells don't respond well to insulin — a hormone that regulates glucose (sugar) levels in the blood. As its name suggests, gestational diabetes develops only in pregnant women. It's caused by changes in the body (including changing hormone levels) during pregnancy, and causes high blood glucose levels. If left uncontrolled, the condition may be harmful — or even deadly — to both the woman and her child, and can increase both of their risks of developing type 2 diabetes later in life. The key to treating gestational diabetes is to tightly regulate blood glucose levels through lifestyle changes (diet and exercise) and, if necessary, medications. Gestational Diabetes Diet Treatment for gestational diabetes always includes specialized healthy meal plans — often recommended by a registered dietician — and regular exercise, according to the American Diabetes Association (ADA). Generally speaking, diets for gestational diabetes focus on foods high in fiber and other important nutrients, and low in fat and calories. This means they tend to favor vegetables, fruits, and whole grains, and frown on refined carbohydrates (including sugar). According to a 2008 report in the journal Reviews in Obstetrics and Gynecology, a diet that can help most women with gestational diabetes maintain a normal blood glucose level is one in which 33 to 40 percent of calories come from complex carbohydrates, 35 to 40 percent come from fat, and 20 percent come from protein. Eating regular small meals throughout the day can also help keep your blood glucose level stable. Exercise as Treatment for Gestational Diabetes Regular physical activity is important to help keep your blood glucose under control. Women with ges Continue reading >>

Oral Medication For The Treatment Of Women With Gestational Diabetes

Oral Medication For The Treatment Of Women With Gestational Diabetes

What is the issue? Globally the number of women being diagnosed with gestational diabetes mellitus (GDM) is increasing. GDM is an intolerance to glucose leading to high blood sugars, first recognised during pregnancy and usually resolving after birth. Standard care involves lifestyle advice on diet and exercise. Treatment for some women includes oral anti-diabetic medications, such as metformin and glibenclamide, which are an alternative to, or can be used alongside, insulin to control the blood sugar. This review aimed to investigate benefits of taking oral medication to treat GDM in pregnant women. Another Cochrane Review compares the effects of insulin with oral anti-diabetic pharmacological therapies ( Brown 2016). Why is this important? Women diagnosed with GDM are at a greater risk of experiencing complications such as high blood pressure during pregnancy and at birth. They have an increased risk of developing diabetes later in life. The babies of women who have been diagnosed with GDM can be larger than normal and this can cause injuries to the mother and the baby at birth. The birth is more likely to be induced or the baby born by caesarean section. These babies are at risk of developing diabetes as children or young adults. Finding the best medications to treat the women and prevent the complications that are linked to GDM is therefore important. What evidence did we find? We searched for studies on 14 May 2016. We included 11 randomised controlled trials involving 1487 mothers and their babies (but only eight trials contributed data to our analyses). The evidence was limited by the quality and number of studies and we advise caution when looking at the results. The criteria for diagnosis of GDM and treatment targets varied between studies, and each outcome is Continue reading >>

Oral Anti-diabetic Pharmacological Therapies For The Treatment Of Women With Gestational Diabetes

Oral Anti-diabetic Pharmacological Therapies For The Treatment Of Women With Gestational Diabetes

iOral anti-diabetic pharmacological therapies for the treatment of women with gestational diabetes (Protocol) Copyright 2015 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd. Oral anti-diabetic pharmacological therapies for the treatment of women with gestational diabetes Julie Brown1, Ruth Martis1, Brenda Hughes2, Janet Rowan3, Caroline A Crowther1 1Liggins Institute, The University of Auckland, Auckland, New Zealand. 2Pharmacy, Auckland City Hospital, Auckland, New Zealand. 3National Womens Health, Auckland, New Zealand Contact address: Julie Brown, Liggins Institute, The University of Auckland, Park Rd, Grafton, Auckland, 1142, New Zealand. Editorial group: Cochrane Pregnancy and Childbirth Group. Publication status and date: New, published in Issue 11, 2015. Citation: Brown J, Martis R, Hughes B, Rowan J, Crowther CA. Oral anti-diabetic pharmacological therapies for the treat- ment of women with gestational diabetes. Cochrane Database of Systematic Reviews 2015, Issue 11. Art. No.: CD011967. DOI: Copyright 2015 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd. This is the protocol for a review and there is no abstract. The objectives are as follows: To evaluate the effectiveness of oral agents in treating women with gestational diabetes for improving maternal and fetal health and The original review by Alwan et al Treatments for gestational diabetes (Alwan 2009) has been split into three new review titles reecting the complexity of treating women with gestational diabetes. Lifestyle interventions for the treatment of women with gestational Oral anti-diabetic pharmacological therapies for the treatment of women with gestational diabetes mellitus (this review) Insulin for the treatment of women with gestational diabetes mellitus There wi Continue reading >>

Safety Of Oral Antidiabetic Agents In Pregnancy

Safety Of Oral Antidiabetic Agents In Pregnancy

Safety of oral antidiabetic agents in pregnancy The three most potent human teratogens, with the possible inclusion of some of the first antineoplastics, are isotretinoin, alcohol, and hyperglycemia. As with all teratogens, the toxicity is dose related. For example, the risk of embryo-fetal harm from hyperglycemia increases markedly when the HbA1c is greater than 8%. Moreover, diabetes accounts for more than 90% of the harm caused by chronic diseases. Consequently, control of glucose levels in pregnancy is critical. Although the American College of Obstetricians and Gynecologists recommends insulin as the drug of choice for all diabetes types, oral antidiabetic agents are often used in type 2 and gestational diabetes if diet control and exercise have not been effective. Consistent with its molecular weight (5808), insulin does not cross the human placenta, at least in clinically significant amounts. In contrast, the oral agents have molecular weights ranging from 166 to 646, strongly suggesting that they will cross to the human embryo-fetus throughout pregnancy. If these agents are used near term, there is a risk that they will cause hypoglycemia in the newborn. Changing from oral therapy to insulin is the safest course. There are seven pharmacologic subclasses of oral antidiabetic agents: alpha-glucosidase inhibitors, biguanides, dipeptidyl peptidase-4 inhibitors, meglitinides, sulfonylureas, sodium-glucose cotransporter-2 inhibitors, and thiazolidinediones. Many of these drugs are available in combination with metformin. All of these agents are indicated as adjunct to diet and exercise for type 2 diabetes, but they also can be used for gestational diabetes. Although the human pregnancy data are very limited or nonexistent for most of these agents, none are known to c Continue reading >>

The Use Of Oral Antidiabetic Medications In Gestational Diabetes Mellitus

The Use Of Oral Antidiabetic Medications In Gestational Diabetes Mellitus

, Volume 9, Issue4 , pp 287290 | Cite as The use of oral antidiabetic medications in gestational diabetes mellitus Gestational diabetes mellitus (GDM) is defined as carbohydrate intolerance with onset or first recognition during pregnancy. When medical nutrition therapy is not successful in maintaining target glucose values during pregnancy complicated by GDM, medication is required. Insulin has been the traditional treatment under such circumstances. The use of oral antidiabetic medications in the management of gestational diabetes has increased over the past several years. Recent studies have shown the equivalence to insulin of both glyburide and metformin in terms of pregnancy outcomes in GDM. However, both agents have been shown to cross the placenta to the fetus, and thus they should be used with caution and patients counseled appropriately. MetforminHypoglycemiaGestational Diabetes MellitusObstet GynecolSulfonylurea These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves. This is a preview of subscription content, log in to check access Unable to display preview. Download preview PDF. Hunt KJ, Schuller KL: The increasing prevalence of diabetes in pregnancy. Obstet Gynecol Clin North Am 2007, 34:173199. PubMed CrossRef Google Scholar Langer O: Maternal glycemic criteria for insulin therapy in gestational diabetes mellitus. Diabetes Care 1998, 21(Suppl 2):B91B98. PubMed Google Scholar Langer O, Rodriguez DA, Xenakis EM, et al.: Intensified vs. conventional management of gestational diabetes. Am J Obstet Gynecol 1994, 170:10361047. PubMed Google Scholar Crowther CA, Hiller JE, Moss JR, et al.: Effect of treatment of gestational diabetes mellitus on pregnancy outcomes Continue reading >>

Could Metformin Manage Gestational Diabetes Mellitus Instead Of Insulin?

Could Metformin Manage Gestational Diabetes Mellitus Instead Of Insulin?

Copyright © 2016 Hend S. Saleh et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Abstract Gestational diabetes mellitus (GDM) complicates a significant number of pregnancies. Blood glucose control improves perinatal outcomes. Medical nutrition therapy is the foundation in management. Aim of This Study. To evaluate efficacy of metformin in comparison to insulin for managing GDM. Methods. In prospective randomized comparative study, 150 antenatal women whose pregnancies had been complicated by GDM and did not respond to diet alone were recruited from antenatal clinics at Obstetrics Department in Zagazig University Hospitals from November 2012 to December 2014. They were divided randomly into two groups, 75 patients in each, and were subjected to either insulin or metformin medication. Outcomes were comparing the effects of both medications on maternal glycemic control, antenatal complications, and neonatal outcome. Results. No significant difference in controlling high blood sugar in GDM with the use of metformin or insulin (, 0.15). Maternal complications in both groups had no significant difference and fetal outcomes were as well similar except the fact that the hypoglycemia occurred more in insulin group with value 0.01. Conclusion. Glycaemic control in GDM can be achieved by using metformin orally without increasing risk of maternal hypoglycemia with satisfying neonatal outcome. 1. Introduction Gestational diabetes mellitus (GDM) is a condition with any level of glucose intolerance which began or was detected for first time during pregnancy despite type of management; it may also relate to situatio Continue reading >>

Metformin

Metformin

Metformin, marketed under the trade name Glucophage among others, is the first-line medication for the treatment of type 2 diabetes,[4][5] particularly in people who are overweight.[6] It is also used in the treatment of polycystic ovary syndrome.[4] Limited evidence suggests metformin may prevent the cardiovascular disease and cancer complications of diabetes.[7][8] It is not associated with weight gain.[8] It is taken by mouth.[4] Metformin is generally well tolerated.[9] Common side effects include diarrhea, nausea and abdominal pain.[4] It has a low risk of causing low blood sugar.[4] High blood lactic acid level is a concern if the medication is prescribed inappropriately and in overly large doses.[10] It should not be used in those with significant liver disease or kidney problems.[4] While no clear harm comes from use during pregnancy, insulin is generally preferred for gestational diabetes.[4][11] Metformin is in the biguanide class.[4] It works by decreasing glucose production by the liver and increasing the insulin sensitivity of body tissues.[4] Metformin was discovered in 1922.[12] French physician Jean Sterne began study in humans in the 1950s.[12] It was introduced as a medication in France in 1957 and the United States in 1995.[4][13] It is on the World Health Organization's List of Essential Medicines, the most effective and safe medicines needed in a health system.[14] Metformin is believed to be the most widely used medication for diabetes which is taken by mouth.[12] It is available as a generic medication.[4] The wholesale price in the developed world is between 0.21 and 5.55 USD per month as of 2014.[15] In the United States, it costs 5 to 25 USD per month.[4] Medical uses[edit] Metformin is primarily used for type 2 diabetes, but is increasingly be Continue reading >>

Pharmacological Management Of Gestational Diabetes

Pharmacological Management Of Gestational Diabetes

An overview Abstract OBJECTIVE—To provide a review of the background literature regarding the pharmacological management of gestational diabetes. RESEARCH DESIGN AND METHODS—This is a literature review. RESULTS—Information is available regarding the use of some, but not all, oral antidiabetes agents in pregnancy. CONCLUSIONS—Available evidence supports the use of glyburide during pregnancy. Evidence is inadequate to support or refute the use of metformin, an agent that has been shown to cross the placenta and thus could be helpful or harmful to the developing fetus. Because insulin preparations tested to date have been determined not to cross the placenta or to cross minimally, insulin has been the treatment of choice in most parts of the world for patients with gestational diabetes whose circulating glucose levels exceed predetermined thresholds. Although advances have been made in developing insulins that may be administered by alternative routes, insulin is typically injected subcutaneously. This poses a barrier to utilization and has been one of the factors that kindled interest over many years in treating gestational diabetes with oral antidiabetic agents. This and the following presentations describe oral agents that have the potential to be used as alternatives to insulin for the treatment of gestational diabetes. In this overview, I shall outline some guiding principles in determining whether a particular agent is appropriate for use in pregnancy and then apply these principles to the most commonly used oral antidiabetes agents. GUIDING PRINCIPLES— As our understanding of the physiology and pharmacology of both pregnancy and diabetes has increased, some guiding principles have emerged to help us decide which medications are safe and effective for pregn Continue reading >>

Use Of Oral Anti-diabetic Agents In Pregnancy: A Pragmatic Approach

Use Of Oral Anti-diabetic Agents In Pregnancy: A Pragmatic Approach

Use of Oral Anti-Diabetic Agents in Pregnancy: A Pragmatic Approach We are experimenting with display styles that make it easier to read articles in PMC. The ePub format uses eBook readers, which have several "ease of reading" features already built in. The ePub format is best viewed in the iBooks reader. You may notice problems with the display of certain parts of an article in other eReaders. Generating an ePub file may take a long time, please be patient. Use of Oral Anti-Diabetic Agents in Pregnancy: A Pragmatic Approach Bharti Kalra, Yashdeep Gupta, [...], and Sanjay Kalra Insulin is the gold standard for treatment of hyperglycemia during pregnancy, when lifestyle measures do not maintain glycemic control during pregnancy. However, recent studies have suggested that certain oral hypoglycemic agents (metformin and glyburide) may be safe and be acceptable alternatives. There are no serious safety concerns with metformin, despite it crossing the placenta. Neonatal outcomes are also comparable, with benefit of reductions in neonatal hypoglycemia, maternal hypoglycemia and weight gain, and improved treatment satisfaction. Glibenclamide is more effective in lowering blood glucose in women with gestational diabetes, and with a lower treatment failure rate than metformin. Although generally well-tolerated, some studies have reported higher rates of pre-eclampsia, neonatal jaundice, longer stay in the neonatal care unit, macrosomia, and neonatal hypoglycaemia. There is also paucity of long-term follow-up data on children exposed to oral agents in utero. This review aims to provide an evidence-based approach, concordant with basic and clinical pharmacological knowledge, which will help medical practitioners use oral anti-diabetic agents in a rational and pragmatic manner. P Continue reading >>

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