Active Ingredient: Orlistat
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Insulin, which has long been considered last-line therapy in the treatment of T 2 DM and is the primary treatment of Type 1 Diabetes Mellitus T 1 DM, insulin-dependent DM, is now a viable addition to metformin as a second-line agent in lieu of sulfonylureas.
Insulin is effective in reducing blood glucose and HbA 1 C. Insulin regimens are patient-specific and can involve various combinations. Other less validated classes of medications that can be added to metformin include the thiazolidinediones TZDs and GLP-1 agonists glucagon-like peptide-1.
In the United States, TZDs carry a black box warning of increased cardiovascular events due to a trial that demonstrated an increased risk of myocardial events with rosiglitazone.
GLP-agonists exenatide, liraglutide are peptides derived from naturally occurring incretin hormones produced in the small intestines after meals.
It binds to GLP-1 receptors in the pancreas to stimulate insulin secretion and suppress glucagon secretion.
There is a reduced risk of hypoglycemia with the meglitinides. Endogenous amylin and its analogues pramlintide bind to amylin receptors in the brain.
While the use of pharmacological approaches for prevention is not routinely practiced, the ADA recommends that health-care practitioners consider the use of metformin in patients who are at high risk for developing diabetes.
As such, metformin is the only current medication that has been advocated to be used in the prevention of diabetes in high-risk populations such as those with a history of gestational diabetes, morbidly obese, and those with progressive hyperglycemia.
In women receiving 400 mg troglitazone for 30 months, the cumulative incidence of diabetes was reduced significantly in treated women 5. Troglitazone was discontinued in the USA in 1998 due to potential liver damage associated with the drug.
Over 1300 patients with impaired glucose tolerance in a multi-center study were selected for the STOP-NIDDM trial and given either acarbose three times daily or placebo.
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