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Part II Nutrition Assessment, Consequences, and Implications TABLE 13.2 Glucose-Lowering Medications for Type 2 Diabetes

Class and Drugs Biguanide

Metformin (Glucophage) Metformin ER/XR (Glucophage XR) Metformin hydrochloride (Fortamet)

Liquid form of metformin Hcl (Riomet)

Sulfonylureas (Second Generation)

Glipizide (Glucotrol; Glucotrol XL) Glyburide (Glynase PresTabs)

Glimepiride (Amaryl) Meglitinides

Repaglinide (Prandin) Nateglinide (Starlix)

Thiazolidinediones Pioglitazone (Actos) Rosiglitazone (Avandia)

Pancreas

Stimulate insulin secretion from the beta cells

Muscle

Improve peripheral insulin sensitivity

Lower risk of

hypoglycemia than sulfonylureas

Used before meals and are short-acting

Weight gain Edema

Heart failure Bone fractures

Glucagon-like Peptide-1 (GLP-1) Receptor Agonists Exenatide (Byetta)

Exenatide extended release (Bydureon) Liraglutide (Victoza) Albiglutide (Tanzeum) Dulaglutide (Trulicity)

Dipeptidyl Peptidase-4 (DPP- 4) Inhibitors

Sitagliptin (Januvia) Saxagliptin (Onglyza) Linagliptin (Tradjenta) Alogliptin (Nesina)

Gastrointestinal tract, pancreas, liver Eenhance glucose- dependent insulin release; suppress postprandial glucagon secretion; slow gastric emptying

Increase satiety

Pancreas and liver Enhance effects of GLP-1 and GIP by preventing degradation

Nausea, vomiting

Exenatide can be injected up to 60 min prior to meal. If nausea and/or vomiting occur, try moving injection closer to meal—10 to 20 min or immediately before eating

No major side effects Possible cold symptoms

Should be used with caution in elderly patients with coronary heart failure due to associated edema and weight gain

Associated nausea and weight loss may be problematic in frail elderly patients

Injection therapy may be a problem

Pancreas

Stimulate insulin secretion from the beta cells

Hypoglycemia Weight gain

Loss of response with time

Avoid use of glyburide

Site and Mechanism of Action

Liver

Decrease hepatic glucose production

Adverse Effects/Nutrition Considerations

Nausea, vomiting, diarrhea, and gas May be able to reduce side effects by slowly increasing dose and taking with a meal

Concerns in Older Adults

Dose should be reduced in patients with stage 3 chronic kidney disease (CKD) and avoided in those with stage 4 or worse