18 June, 2017

NEW DRUG FOR DIABETES!!

There has always been a search for better... With the advent of newer drugs this search for better drugs has taken a positive turn. In the recent years the trend of management of Diabetes has been more optimistic and sophisticated. We want to prescribe drugs with multiple function. The aim of Diabetes management has always been to attain the Golden number – HbA1c <7. Along with this if a drug can minimise or tackle the development of comorbidities it is like getting double increment at one shot. The life expectancy of people with Diabetes has gone up which is a welcome change. Along with the increased duration of diabetes comes increase in rate of comorbidities like Hypertension, Dyslipidemia, other endocrine abnormalities to mention a few. Right from the day metformin was introduced along with sulphonylureas they have ruled Diabetes management as uncrowned kings.


There existed an uncertainty regarding the 3rd OHA... many options came and went... the recent decade saw Rosiglitazone as an alternative followed by Pioglitazone then Acarbose and finally voglibose. Individually all are good drugs and with reasonable clinical acumen these drugs can be prescribed safely but like any other allopathic drugs these drugs have some side effects. Rosiglitazone was withdrawn from market citing side effects. Pioglitazone on the other hand faced some controversies and made it to the news paper headlines. The notable issues apart from the controversies was that the drug may increase body weight in some patients, it can cause swelling of legs and is a strict no – no in poor cardiac status. Acarbose and Voglibose on the other hand were short acting drugs targeting only the post prandial rise in blood sugars. The main issue revolving around this group of drugs was the Gastrointestinal side effects and the lack of prolonged action.
            Era of DPP-IV inhibitors started with gliptins. The first one to hit the market was sitagliptin and was priced exorbitantly. Soon there were cousins flooding the market... next came vildagliptin followed by saxagliptin... let us not focus on the merits and demerits of each drug. Basically these drugs helped prolong the action of available insulin in the body. The latest gliptin to hit the market is Teneligliptin. This drug was first discovered by Mitsubishi tanabe pharma corporation. In simple words the mechanism of action of this drug is prevents enzymatic degradation of insulin in the body. Since the insulin destruction post release from pancreas is decreased , the available insulin acts longer bringing down the Blood sugar levels. As per the data provided Teneligliptin is safe as a add-on drug along with Sulphonylureas, Metformin or glitazones. This drug claims to have a very good safety profile with lesser adverse events. Although large scale post marketing surveys are awaited this drug boasts of positive effect on dietary triglycerides, no dose adjustment required in patients with renal impairment, better insulin reserves as well as a good impact on body weight. The recommended dosage is 20mg and can be increased to 40mg. A new molecule is always welcome in diabetes management but needs to prove all its claims in large scale ,long term & uninfluenced post marketing surveys. Till then let’s keep our fingers crossed and prescribe with caution. Patients please discuss with your doctor regarding this drug before venturing post google search.

Stay safe.... Stay Healthy.... 

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