2. PHARMACOTHERAPEUTICS
• It is a branch of pharmacology that deals with the selection of the most
appropriate drug, dose, dosage form and duration of treatment by
taking the stage of disease into account .
• It is principally concerned with safe and effective management of drug
administration.
• It is the achievement of the desired therapeutic goal from drug
therapy.
3. DIABETES MELLITUS
• Diabetes is a group of metabolic disorders characterized by chronic hyperglycemia (fasting
plasma glucose > 126 mg/dL and > 200mg/dL 2 hours after 75g oral glucose)
• Most common endocrine disorder.
• Diabetes can cause long term damage/dysfunction of various organs.
E.g.:
1. Eyes : Visual acuity , lens opacification
2. Liver : Hepatomegaly
3. Hands: Stiffness of hands, limited joint mobility
4. Skin : Discoloration of skin , etc
4.
5. CLASSIFICATION
• Type I / Insulin dependent/ Juvenile onset DM : Due to beta cell destruction in
pancreatic islets either by autoimmune destruction ( Type I A ) or idiopathic ( Type I B
)
• Type II / Non Insulin dependent DM / Maturity onset DM : Due to increased
peripheral insulin resistance
• Gestational DM
• Other specific types like genetic defects of beta cell function, genetic defects in insulin
action , etc
6. The classical symptoms of thirst,
polyuria, nocturia and rapid
weight loss are prominent in type
1 diabetes, but are often absent
in patients with type 2 diabetes,
many of whom are asymptomatic
or have non-specific complaints
such as chronic fatigue and
malaise.
7. EPIDEMIOLOGY
• Type 2 diabetes is much more common than type 1, 90% of people with diabetes.
• In UK, type 2 diabetes currently affects approximately 2.3 million people, and up to
another 500,000 are thought to be undiagnosed.
• In northern Europe, the prevalence of Type I diabetes is approximately 0.3% in
those under 30 years of age.
• The estimates in 2019 showed that 77 million individuals had diabetes in India.
8. THERAPEUTIC GOALS
1. To achieve almost normal metabolism.
2. To relieve the symptoms of hyperglycemia .
3. To achieve a normal life.
9. MANAGEMENT
1. Non- Pharmacological Measures : Diet , Exercise and other lifestyle modifications.
2. Pharmacological Measures : Drug Therapy (oral anti-diabetic drugs and injected
therapies )
3. Educating patients
In patients with suspected type 1 diabetes, urgent treatment with insulin is
required. In patients with suspected type 2 diabetes, the first line of therapy
involves advice about dietary and lifestyle modification. Oral antidiabetic drugs are
added in those who do not achieve glycemic targets as a result, or who have severe
symptomatic hyperglycemia at diagnosis and a high HbA 1C ( glycated hemoglobin )
10. DIET
• Consumption of foods with a low glycemic index ex.
Starch, basmati rice, bread, beans, lentils, etc.
• The intake of total fat should be restricted to less than
35% of energy intake,through consumption of oils and
spreads made from olive, rapeseed or groundnut oils.
• Salt restriction
• High protein intake
11. LIFESTYLE MODIFICATIONS
• Weight management : A high percentage of people with type 2 diabetes are overweight or
obese. Weight loss can be achieved through a reduction in energy intake and an increase in
energy expenditure through physical activity.
• Exercise
• Alcohol : Drinks containing alcohol can be a substantial source of calories and total intake
may have to be reduced to assist weight reduction.
13. BIGUANIDES
• Metformin is the only biguanide currently used.
• It is the first-line therapy for Type II DM
• The glucose lowering effect of metformin is synergistic with that of sulphonylureas
therefore both are combined along and administered.
• Metformin is given with food, usually starts with 500mg 12-hourly, gradually
increased as required to a maximum of 1g 8-hourly.
• Its use is contraindicated in patients with impaired renal or hepatic function.
Side effects :Anorexia, nausea, abdominal discomfort and diarrhoea
14. ALPHA-GLUCOSIDASE INHIBITORS
• The α-glucosidase inhibitors delay carbohydrate absorption. Acarbose and miglitol are
available and are taken with each meal
THIAZOLIDINEDIONES/ PPARγ AGONIOSTS
• Pioglitazone or rosiglitazone are prescribed as second-line therapy with metformin, or as
third-line therapy in combination with sulphonylurea and metformin (known as ‘triple
therapy’)
INCRETIN-BASED THERAPIES
• Exenatide are most useful in obese patients and can be used in combination with other oral
anti-diabetic agents.
15. INSULIN THERAPY
• The only drug of choice for Type I DM.
• Recombinant DNA technology enabled large-scale production of human insulin.
• Insulin is injected subcutaneously several times a day into the anterior abdominal
wall, upper arms, outer thighs
• Short-acting insulin has to be injected at least 30 minutes before a meal to allow
adequate time for absorption. E.g. Regular
• The rapidly absorbed fast-acting insulin analogues can be administered immediately
before, during or even after meals. E.g. Lispro, Aspart
Side effects: Hypoglycaemia, Weight gain, Peripheral oedema, Local allergy (rare),
Lipodystrophy at injection site.
16. REFERENCES
• Roger Walker Clinical Pharmacy and Therapeutics-5th-Ed., Pg no: 685-707
• Davidson’s Principles and Practice of Medicine 2021st Ed., Pg no: 797-824
• Pharmacotherapy Handbook, 7th Ed, Pg no. 210
