Doctoral Program in Pharmacy, Faculty of Pharmacy, Padjadjaran University, Sumedang 45363, West Java, Indonesia.
Faculty of Pharmacy, Bhakti Kencana University, Bandung 40614, West Java, Indonesia.
Med Sci (Basel). 2023 Aug 15;11(3):50. doi: 10.3390/medsci11030050.
Type 2 diabetes mellitus (T2DM) is the world's most common metabolic disease. The development of T2DM is mainly caused by a combination of two factors: the failure of insulin secretion by the pancreatic β-cells and the inability of insulin-sensitive tissues to respond to insulin (insulin resistance); therefore, the disease is indicated by a chronic increase in blood glucose. T2DM patients can be treated with mono- or combined therapy using oral antidiabetic drugs and insulin-replaced agents; however, the medication often leads to various discomforts, such as abdominal pain, diarrhea or constipation, nausea and vomiting, and hypersensitivity reactions. A biguanide drug, metformin, has been used as a first-line drug to reduce blood sugar levels. Sulfonylureas work by blocking the ATP-sensitive potassium channel, directly inducing the release of insulin from pancreatic β-cells and thus decreasing blood glucose concentrations. However, the risk of the failure of sulfonylurea as a monotherapy agent is greater than that of metformin or rosiglitazone (a thiazolidinedione drug). Sulfonylureas are used as the first-line drug of choice for DM patients who cannot tolerate metformin therapy. Other antidiabetic drugs, thiazolidinediones, work by activating the peroxisome proliferator-activated receptor gamma (PPARγ), decreasing the IR level, and increasing the response of β-cells towards the glucose level. However, thiazolidines may increase the risk of cardiovascular disease, weight gain, water retention, and edema. This review article aims to discuss case reports on the use of metformin, sulfonylureas, and thiazolidinediones in DM patients. The literature search was conducted on the PubMed database using the keywords 'metformin OR sulfonylureas OR thiazolidinediones AND case reports', filtered to 'free full text', 'case reports', and '10 years publication date'. In some patients, metformin may affect sleep quality and, in rare cases, leads to the occurrence of lactate acidosis; thus, patients taking this drug should be monitored for their kidney status, plasma pH, and plasma metformin level. Sulfonylureas and TZDs may cause a higher risk of hypoglycemia and weight gain or edema due to fluid retention. TZDs may be associated with risks of cardiovascular events in patients with concomitant T2DM and chronic obstructive pulmonary disease. Therefore, patients taking these drugs should be closely monitored for adverse effects.
2 型糖尿病（T2DM）是世界上最常见的代谢疾病。T2DM 的发展主要是由两个因素共同作用引起的：胰腺β细胞胰岛素分泌衰竭和胰岛素敏感组织对胰岛素的反应能力下降（胰岛素抵抗）；因此，疾病表现为慢性血糖升高。T2DM 患者可以通过使用口服降糖药和胰岛素替代剂的单药或联合治疗进行治疗；然而，药物治疗常常会导致各种不适，如腹痛、腹泻或便秘、恶心和呕吐以及过敏反应。二甲双胍类药物二甲双胍已被用作降低血糖水平的一线药物。磺酰脲类药物通过阻断 ATP 敏感性钾通道，直接诱导胰腺β细胞释放胰岛素，从而降低血糖浓度。然而，磺酰脲类药物作为单一疗法的失败风险大于二甲双胍或罗格列酮（噻唑烷二酮类药物）。磺酰脲类药物被用作不能耐受二甲双胍治疗的 DM 患者的一线首选药物。其他降糖药物，噻唑烷二酮类，通过激活过氧化物酶体增殖物激活受体γ（PPARγ）起作用，降低 IR 水平，并增加β细胞对葡萄糖水平的反应。然而，噻唑烷二酮类药物可能会增加心血管疾病、体重增加、水潴留和水肿的风险。本文旨在讨论二甲双胍、磺酰脲类药物和噻唑烷二酮类药物在 DM 患者中的应用的病例报告。文献检索在 PubMed 数据库中进行，使用的关键词是“metformin OR sulfonylureas OR thiazolidinediones AND case reports”，筛选条件为“free full text”、“case reports”和“10 年出版日期”。在一些患者中，二甲双胍可能会影响睡眠质量，在极少数情况下会导致乳酸性酸中毒的发生；因此，服用这种药物的患者应监测其肾脏状况、血浆 pH 值和血浆二甲双胍水平。磺酰脲类药物和 TZDs 可能会因液体潴留而导致低血糖和体重增加或水肿的风险增加。TZDs 可能与同时患有 T2DM 和慢性阻塞性肺疾病的患者的心血管事件风险相关。因此，服用这些药物的患者应密切监测不良反应。
