In recent years, the development of oral anti-diabetic drugs has been rapid. Existing types have continuously given rise to new drugs and formulations, and new types have also been discovered and used in clinical practice.
Currently available oral anti-diabetic drugs on the market mainly include:
Insulin secretagogue
such as Glibenclamide, Gliclazide, Glipizide controlled-release tablets, Guanidine, Glimepiride, repaglinide tablets, and Nateglinide.
Insulin sensitizers
such as Phenylephrine, Metformin, Rosiglitazone maleate tablets, and Pioglitazone.
glycosidase inhibitors
such as Acarbose, Acarbose tablets, and Voglibose Tablets.
The development of oral anti-diabetic drugs
The development of oral anti-diabetic drugs has been a significant area of research and innovation in the field of diabetes management. Here is a brief overview of the historical progression of these medications:
- Sulfonylureas: The first oral anti-diabetic drugs, sulfonylureas, were introduced in the 1950s. These drugs work by stimulating the pancreas to produce more insulin. The first sulfonylurea, tolbutamide, was followed by other agents such as chlorpropamide, glibenclamide, and glimepiride.
- Biguanides: The introduction of biguanides, with metformin being the most widely used, began in the 1950s but faced initial setbacks due to safety concerns. It was not until the 1990s that metformin was reintroduced and recognized as a cornerstone in the treatment of type 2 diabetes. Metformin works by reducing glucose production in the liver and improving insulin sensitivity.
- Thiazolidinediones (TZDs): These drugs, which include rosiglitazone and pioglitazone, were introduced in the late 1990s. TZDs enhance insulin sensitivity by activating peroxisome proliferator-activated receptor gamma (PPAR-γ), which helps regulate glucose and fatty acid metabolism.
- Alpha-glucosidase inhibitors: These drugs, such as acarbose and miglitol, were developed to slow the digestion of carbohydrates, thereby reducing the postprandial glucose spike. They work by inhibiting the enzymes that break down carbohydrates in the gut.
- Dipeptidyl peptidase-4 (DPP-4) inhibitors: Introduced in the early 2000s, these drugs, including sitagliptin, saxagliptin, and linagliptin, enhance insulin secretion and reduce glucagon secretion by inhibiting the breakdown of incretin hormones.
- Sodium-glucose cotransporter 2 (SGLT2) inhibitors: These relatively new drugs, such as canagliflozin, dapagliflozin, and empagliflozin (developed by Boehringer Ingelheim and Eli Lilly and Company), were approved in the 2010s. They work by blocking the reabsorption of glucose in the kidneys, leading to increased glucose excretion in the urine.
Each of these classes of oral anti-diabetic drugs has contributed to the evolving landscape of diabetes treatment, offering a range of mechanisms to control blood sugar levels and improve patient outcomes. The ongoing research and development in this field continue to focus on enhancing efficacy, reducing side effects, and addressing the unmet needs of patients with diabetes.
