Repaglinide and Insulin Glargine Anti-diabetic Drugs

In the contemporary world, the overall prevalence of the diabetes epidemic is increasing at an alarming rate and thus the utter need to focus exclusively on the diabetes management through the various anti-diabetic medications and improving on some of the lifestyle factors that are a significant cause of the disease. Currently, the International Diabetes Foundation estimates the number of adults infected with diabetes to be 366 million across the globe while millions more perceived to be suffering from the condition although they are currently undiagnosed (Babiker & Al Dubayee, 2017). Undeniably, the treatment cost of the disease, as well as its adverse complications, has also increased substantially resulting in an economic burden on the healthcare systems worldwide. As such, diabetics' pharmacology has become a significant topic of research in the healthcare sector in an attempt to review the effectiveness and understand the clinical considerations of the available primary categories of anti-diabetic medication. The anti-diabetic medications are adequately described as a group of pharmacological agents, which have been accepted as sufficient for hyperglycemic treatment in, types two diabetes mellitus (Kizior, Rph & Hodgson, 2019). In cases where, lifestyle modifications including activities like exercise and dietary change does not significantly decrease the hemoglobin AIC levels to approximately 7 percent, the pharmacological medication with the different anti-diabetic drugs is put into consideration.

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Furthermore, the drugs are often classified regarding their mechanism of action either as insulinotropic or non-insulinotropic. Choosing the appropriate medication for patients with diabetes; however, entails the consideration of various factors such as the effects on the weight or the newborn during lactation (Kizior, Rph & Hodgson, 2019). A vast literature has been written concerning the same by multiple healthcare professionals providing significant sources about the mechanisms of action and side effects of the principal categories of anti-diabetic drugs. The chief aim of this paper is thus to give a substantial literature review on two main types of anti-diabetic medication, the Repaglinide and Insulin Glargine by explicitly stating the drug classification and its impacts on the patient, how these drugs are metabolized and excreted, their common side effects and the mechanism of action. The most successful approach to the medication of diabetes type 1 and 2 is to accomplish the paramount and suitable glucose control. Many past clinical trials have however revealed that both Repaglinide and Insulin Glargine play a vital role in the treatment and prevention of diabetes in both adults and children.

Repaglinide

The overall medication of patients who have diabetes as explained in the Merck's Manual also commonly known as MSD Manuals professional version comprises of lifestyle modifications like exercise and diet. Also, the consistent monitoring of blood glucose levels is vital to avert complications associated with the drug treatment of Diabetes Mellitus (MsdManuals.com, 2018). According to McCuiston pharmacology, Repaglinide is broadly defined as an oral antihyperglycemic agent that is efficiently used as the medication of non-insulin dependent diabetes mellitus (McCuistion Pharmacology, 2017). This drug is classified as a meglitinide category of the short-acting insulin secretagogues that primarily acts by binding to the v cells within the pancreas to enhance the release of insulin. The Merck's Manual professional describes the oral antihyperglycemic drugs as the foundation of type 2 diabetes mellitus treatment (MsdManuals.com, 2018). Also, insulin may be added when more than three drugs do not provide sufficient glycemic control. Repaglinide plays a significant role in the treatment of diabetes by impairing the GI absorption of glucose, increasing glycosuria and the pancreatic insulin secretion as well as sensitizing the peripheral tissues to insulin.

The McCuiston pharmacology further explains that Repaglinide introduces an early response of insulin to meals thereby reducing the postprandial blood glucose levels. This drug should only be administered with meals while the meal-time doses should be avoided along with any skipped meal (McCuistion Pharmacology, 2017). However, therapy for about one month is recommended before a reduction in fasting blood glucose is evident (Kizior, Rph & Hodgson, 2019). Concerning, the pharmacology of the drug, its mechanism of action as explained in the Emedicine Medscape it substantially increases the secretion of insulin by obstructing the main channels of ATP potassium within the beta islet cells that are responsible for the entrance of calcium via the calcium channels (Mediscape.com). Therefore, the release of insulin from the pancreatic beta cells is often augmented by the intracellular calcium.

Repaglinide anti-diabetic is largely metabolized in the liver by both the CYP2C8 and CYP3A4 resulting in an oxidized dicarboxylic acid and 90 percent excreted mainly through feces while 8 percent is eliminated via urine (Kizior, Rph & Hodgson, 2019). The Medscape association in their article regarding repaglinide highlights that only limited data is available concerning the drug associated risks of the drug during pregnancy and lactation. However, if diabetes during pregnancy is not controlled effectively it many increases the chances of maternal risk for diabetic preeclampsia, delivery complications and can also leads to preterm delivery and congenital disabilities (Mediscape.com). Even as a result of the presence of potential hypoglycemia in breastfeeding newborns, this drug is not recommended for use by lactating mothers. From the drug monograph, Repaglinide is associated with several contraindications mainly in patients with diabetic ketoacidosis, severe liver illness as well as those patients with identified hypersensitivity to the medicine (Repaglinide Product Monograph. Pdf, 2015). Some common side effects of the drug as clearly explained in the American Diabetes Association website for healthcare professionals includes more than 10 percent headaches and hypoglycemia, and other adverse effects that are less than 10 percent includes chest pains, diarrhea, Back pains, constipation among others (American Diabetes Association, 2018). The hypoglycemia complications have been described in the MSD Manual professional version as the most common form of repaglinide adverse side effects, regularly occurring as the patients' attempts to accomplish glucose control and attain normoglycemia.

Insulin Glargine

Insulin Glargine also commonly referred to as Lantus as its brand name is currently a significant form of anti-diabetic medication effectively described as a long-acting type of insulin used in the medication of hyperglycemia mainly caused by both type 1 and 2 of diabetes. Its biological classification is insulin or protein-based therapies (Kizior, Rph & Hodgson, 2019). According to McCuiston pharmacology insulin Glargine is specifically prescribed for the diabetes mellitus treatment since it acts as the endogenous insulin produced by humans, adequately defined as a peptide hormone produced in the pancreases by the beta cells and plays a significant role in promoting glucose metabolism (McCuistion Pharmacology, 2017). This is further noted by Kizior (2019) and collegues in their Nurse Drug Handbook that Insulin is produced from the pancreas after a meal to help the glucose uptake from the blood.

The American Diabetes Association website for healthcare professionals reports that LANTUS is a vital medication in managing diabetes, that is typically caused by the reaction of an autoimmune, which harms the beta cells of the pancreas making it difficult of the body to rlease the insulin required to facilitate the blood sugar level circulation (American Diabetes Association, 2018). The indication of LANTUS as strongly emphasized in the MSD Manuals professional version article is to enhance glycemic control mainly in adults who have type 2 diabetes and in pediatric patients infected with type 1 diabetes (MsdManuals.com, 2018). The mechanism of action of this drug is that it binds into the insulin receptor, described as a protein heterotetrameric. As such, Insulin glargine decreases the level of blood glucose by stimulating the uptake of peripheral glucose, in particular through the skeletal muscle and fat (American Diabetes Association, 2018). The drug then inhibits lipolysis and proteolysis and facilitates protein synthesis mainly in the adipose tissue. LANTUS is however metabolized in the liver into two specific and active metabolites, which functions the same as insulin. The first one is the 21-a-Gly-des-30b- threonine insulin denoted as M2, and the 21a-Gly-human insulin represented as M1 and is the most predominant metabolite (Mediscape.com). Insulin Glargine is majorly eliminated from the body through urine. The Medscape association also highlights that there is no already established report concerning the effects of insulin glargine to the newborn through the mothers who are under this medication during pregnancy (Mediscape.com). Moreover, inappropriately controlled diabetes during pregnancy can adversely affect both the mother and the fetus.

According to the drug monograph, inappropriate drug dosage relative to meal intake at any moment during the day can lead to severe and at times to life-threatening and extended hypoglycemia (Glargine Product Monograph. Pdf, 2017). For all forms of insulin, the hypoglycemia scheduling may vary among the diverse insulin formulations and as a result, glucose monitoring is enormously recommended for all patients who have diabetes (Glargine Product Monograph. Pdf, 2017). Other common side effects associated with the drug include headaches, drowsiness, and difficulty concentrating and injection site reaction. Insulin glargine can be administered through the SC injection within the abdominal area, deltoid or thigh at the same time every day (Mediscape.com). The insulin glargine injection also has several contraindications mostly in patients who are hypersensitive to the medication.

References

American Diabetes Association. (2018). 2. Classification and diagnosis of diabetes: standards of medical care in diabetes-2018. Diabetes care, 41(Supplement 1), S13-S27.Babiker, A., & Al Dubayee, M. (2017). Anti-diabetic medications: How to make a choice?. Sudanese journal of paediatrics, 17(2), 11.Glargine Product Monograph. Pdf (2017). Insulin Glargine Injection (rDNA) Anti-diabetic Agent . Sanofi-Aventis Canada Inc. Submission Control No: 208392, 3-36

Kizior, R. J., Rph, B., & Hodgson, K. (2019). Saunders Nursing Drug Handbook 2020 E-Book. Saunders.

McCuistion Pharmacology (2017). A patient-Centered Nursing Process Approach, Chapter 47; Anti-diabetics, 9th Edition

Mediscape.com (n.d). "Insulin Glagine (Rx)" Retrieved from https://reference.medscape.com/drug/lantus-toujeo-insulin-glargine-999003

Mediscape.com (n.d). "Repaglinide (Rx)" Retrieved from https://reference.medscape.com/drug/prandin-repaglinide-342718#10

MsdManuals.com (2018). "Insulin Glargine 300 Safe, Effective I Seniors with T2DM" Retrievefrom https://www.msdmanuals.com/professional/news/external/2018/06/26/16/07/insulin-glargine-300-safe,-effective-in-seniors-with-t2dm

MsdManuals.com (2018). "Oral Antihyperplycemic Drugs" Retrieved from https://www.msdmanuals.com/professional/endocrine-and-metabolic-disorders/diabetes-mellitus-and-disorders-of-carbohydrate-metabolism/drug-treatment-of-diabetes-mellitus?query=Repaglinide#v29299822

Repaglinide Product Monograph. Pdf (2015). Oral Anti-diabetic Agent ....