Goals of Therapy

Glycemic control, prevention of diabetic complications, and slowing the progression of the disease requires the use of insulin for type 1 diabetics and a combination of oral anti-hyperglycemics and eventually, insulin for many patients who have type 2 diabetes. Patients who have diabetes almost without exception must take diabetes medications. At the same time, there is evidence that nurses’ knowledge of oral and injectable diabetes medications may be incomplete and insufficient. There are some key learning points for the safe use of these anti-hyperglycemics that include each anti-hyperglycemic medication having a specific mechanism of action, and understanding how these diabetes medications work being essential for their safe use.

 

These mechanisms of action include:

Providing an exogenous source of insulin

Stimulating insulin secretion and release

Increasing insulin sensitivity

Decreasing glucagon secretion and glycogenolysis

Increasing renal excretion of glucose

Decreasing/delaying gastric absorption of glucose

 

The anti-hyperglycemics differ in terms of risk for hypoglycemia and risk for weight gain, effectiveness in the level of glucose control, and the adverse effects.

Areas of concern when using diabetes medications include the risk for hypoglycemia; potential for weight gain; the need for dosing adjustments in patients who have renal impairment; the potential for causing and/or exacerbating cardiovascular disease or congestive heart failure; the effects these drugs have on the patient’s lipid profile, and adverse effects that are specific to each drug (like fractures with thiazolidinediones use, amputations with the DPP-IV agonists, and lactic acidosis with metformin).

The choice of which drug to use (aside from insulin for patients who have type 1 diabetes) will depend on many factors, like age and the presence of co-morbidities.

 

What You Need to Know

Given the number of people who have diabetes, the widespread use of anti-hyperglycemics, and the complex pharmacological regimens used to treat the disease, it is imperative that healthcare professionals understand the mechanisms by which the anti-hyperglycemic medications control HbA1c and blood glucose, the risks and benefits of  anti-hyperglycemics, and how and for whom these drugs should be used.

 

More people are developing type 1 and type 2 diabetes during youth, and racial and ethnic minorities continue to develop type 2 diabetes at higher rates. Likewise, the proportion of older people in our nation is increasing, and older people are more likely to have a chronic disease like diabetes. Because diabetes affects the risk for development of many types of complications and additional disease, many related health problems may be prevented or delayed by proper management of diabetes with medications, diet, exercise, and other interventions.  

Healthcare professionals need to know:       The risks and benefits of diabetes medications   Who should use medications      How medications should be used   Prevention and treatment of diabetes early on can reduce risk for other problems later

Diabetes Medications and Associated Complications

Cardiovascular disease, nephropathy, and weight gain are common in patients who have type 2 diabetes, and these issues must be considered when using diabetes medications.

Diabetes medications can have a negative effect on the progression of cardiovascular disease, and some have been associated with, or can cause, major cardiovascular events of congestive heart failure.

Impaired/diminished renal function, which is common in many diabetic patients, can decrease the excretion of some diabetes medications, which may lead to additional and significant complications.

 

And as we discussed, some diabetes medications can lead to weight gain, further making glycemic control difficult.

Complications associated with the use of diabetes medications   cardiovascular disease   nephropathy   weight gain   can lead to congestive heart failure   decreased renal function