CMAJ • January 18, 2005; 172 (2). doi:10.1503/cmaj.1031414.
© 2005 Canadian Medical Association or its licensors
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Right arrow Drugs: endocrine system
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Oral antihyperglycemic therapy for type 2 diabetes mellitus

Alice Y.Y. Cheng and I. George Fantus

From the Department of Medicine, University of Toronto, and the Division of Endocrinology and Metabolism, Department of Medicine, St. Michael's Hospital (Cheng), and the Division of Endocrinology and Metabolism, Department of Medicine, Mount Sinai Hospital and University Health Network and University of Toronto, and the Department of Physiology and Core Laboratory, Banting and Best Diabetes Centre, University of Toronto (Fantus), Toronto, Ont.



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  		Fig. 1: Overview of the pathogenesis of type 2 diabetes mellitus. FFA = free fatty acids. Photo: Lianne Friesen and Nicholas Woolridge

 


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  		Fig. 2: Major target organs and actions of orally administered antihyperglycemic agents in type 2 diabetes mellitus. TZD = thiazolidinedione; FFA = free fatty acid; AGI = {alpha}-glucosidase inhibitor. Photo: Lianne Friesen and Nicholas Woolridge

 

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  		Table 1.

 


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  		Fig. 3: Metformin activates AMPK in liver and muscle to improve glucose and lipid metabolism in type 2 diabetes. (A) shows the ion channel in a resting pancreatic ß cell. (B) shows the action of insulin secretagogues on the cell. AMPK = adenosine monophosphate-activated protein kinase; ACC = acetyl-CoA carboxylase; SREPB-1 = sterol-regulatory-element-binding-protein-1; VLDL = very low density lipoprotein. Photo: Lianne Friesen and Nicholas Woolridge

 

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  		Table 2.

 


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  		Box 1.

 


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  		Fig. 4: Insulin secretagogues mimic glucose to close adenosine triphosphate-sensitive potassium channels (kir6.2) and stimulate insulin secretion. Photo: Lianne Friesen and Nicholas Woolridge

 


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  		Fig. 5: Mechanism of action of thiazolidinediones. PPAR{gamma} = peroxisome proliferator-activated receptor-gamma; TNF-{alpha} = tumour necrosis factor-{alpha}. *There is recent evidence in rodents that skeletal muscle PPAR{gamma}is an important mediator of the beneficial effects of TZDs on insulin sensitivity. Photo: Lianne Friesen and Nicholas Woolridge

 


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  		Fig. 6: Management of hyperglycemia in type 2 diabetes. BMI = body mass index. *When used in combination with insulin, insulin sensitizers may increase the risk of edema of congestive heart failure. The combination of an insulin sensitizer and insulin is currently not an approved indication in Canada. {dagger}If using preprandial insulin, do not add an insulin secretagogue. Reprinted with permission from Can J Diabetes 2003;27(Suppl 2):S39.