- Insulins
- Insulin sensitizers (reduce insulin resistance)
- Secretagogues (stimulate insulin release)
- Agents that slow the digestive/absorptive process:
- Glucagon Like Peptide-1 (GLP-1) Agonists
- Dipeptidyl Peptidase-4 (DPP-4) Inhibitors
- Amylin Analogues
- Sodium-Glucose Transporter-2 (SGLT-2) Inhibitors
- Combination Products
New Antihyperglycemics
Class
|
Generic/Brand/Approval
year
|
SGLT-2 inhibitor
|
Canagliflozin (Invokana), 2013
|
DPP-4 inhibitor
|
Alogliptin (Nesina, Vipidia), 2013
|
SGLT-2 inhibitor
|
Dapagliflozin (Farxiga), 2014
|
SGLT-2 inhibitor
|
Empagliflozin (Jardiance), 2014
|
GLP-1 receptor agonist
|
Albiglutide (Tanzeum), 2014
|
GLP-1 receptor agonist
|
Dulaglutide (Trulicity), 2014
|
Inhaled insulin powder
|
Afrezza, 2014
|
Insulins
Generic
|
Brand Name
|
Rapid Acting
Insulins
|
|
Insulin aspart
|
Novolog
|
Insulin glulisine
|
Apidra
|
Insulin lispro
|
Humalog
|
Insulin human
|
Afrezza Inhalation Powder
|
Short Acting
Insulins
|
|
Regular insulin
|
Humulin R, Novolin R
|
Intermediate
Acting Insulins
|
|
Insulin NPH
|
Hagedorn NPH , Humulin N, Novolin N
|
Long Acting
Insulins
|
|
Insulin detemir
|
Levemir
|
Insulin glargine
|
Lantus
|
Premixed
Insulins
|
|
Insulin aspart protamine/
insulin aspart |
NovoLog 50/50, NovoLog 70/30
|
Insulin lispro protamine/
insulin lispro |
Humalog 50/50, Humalog 75/25
|
Sensitizers
Sensitizers increase the sensitivity of target organs to
insulin.
Biguanides improve peripheral glucose uptake and
utilization.
Generic
|
Brand Name
|
Glucophage, Glucophage XR, Glumetza, Riomet, Fortamet
|
Thiazolidinediones work through the improvement of insulin
sensitivity by acting on adipose, muscle, and liver to increase glucose
utilization and decrease glucose production.
Generic
|
Brand Name
|
Rosiglitazone
|
Avandia
|
Pioglitazone
|
Actos
|
Secretagogues
Secretagogues increase insulin secretion by the pancreas.
Sulfonylureas stimulate insulin release by inhibiting the
KATP channel of the pancreatic beta cells. Sulfonylureas are useful only in
Type II diabetes, as they work by stimulating endogenous release of insulin.
Generic
|
Brand Name
|
First-generation
|
|
Acetohexamide
|
Dymelor
|
Chlorpropamide
|
Diabinese
|
Tolazamide
|
Tolinase
|
Tolbutamide
|
Orinase
|
Second-generation
|
|
Glipizide
|
Glucotrol, Minidiab, Glibenese
|
Glyburide (glibenclamide)
|
Diabeta, Micronase, Glynase, Daonil, Euglycon
|
Glimepiride
|
Amaryl
|
Gliclazide
|
Uni Diamicron
|
Glyclopyramide
|
Deamelin-S
|
Gliquidone
|
Glurenorm
|
Meglitinide derivatives stimulate insulin secretion from
pancreatic cells, lowering blood glucose levels.
Generic
|
Brand Name
|
Nateglinide
|
Starlix
|
Repaglinide
|
Prandin, NovoNorm
|
Alpha-Glucosidase Inhibitors
Alpha-glucosidase inhibitors are not technically
hypoglycemic agents because they do not have a direct effect on insulin
secretion or sensitivity. These medications slow the digestive and absorptive
process, preventing postprandial glucose raise.
Generic
|
Brand Name
|
Acarbose
|
Precose, Glucobay
|
Miglitol
|
Glyset
|
Voglibose
|
Basen
|
GLP-1 analogs decrease both fasting and postprandial blood
glucose levels without causing hypoglycemia 3. Also,
GLP-1 analogs may promote modest weight loss.
Generic
|
Brand Name
|
Short-acting GLP-1 analogs
|
|
Exenatide
|
Byetta
|
Lixisenatide
|
Lyxumia
|
Long-acting GLP-1 analogs
|
|
Liraglutide
|
Victoza
|
Prolonged-acting GLP-1 analogs
|
|
Albiglutide
|
Tanzeum
|
Dulaglutide
|
Trulicity
|
Exenatide once weekly
|
Bydureon
|
Under development
|
|
Taspoglutide
|
Phase III clinical trials 4
|
Dipeptidyl peptidase-4 (DPP-4) inhibitors inhibit DPP-4, the
enzyme that inactivates incretin hormones GLP-1 and GIP.
Generic
|
Brand Name
|
Alogliptin
|
Nesina, Vipidia
|
Anagliptin
|
Suiny
|
Linagliptin
|
Trajenta
|
Saxagliptin
|
Onglyza
|
Sitagliptin
|
Januvia
|
Teneligliptin
|
Tenelia
|
DPP-4 inhibitors under development
|
|
Dutogliptin 5
|
|
Gemigliptin 6
|
|
Pramlintide is a synthetic version of the naturally
occurring pancreatic peptide amylin. Amylin and pramlintide lower
postprandial glucose by lowering postprandial glucagon and delaying gastric
emptying. Pramlintide is indicated for y Type 1 and Type 2 diabetics who use
insulin.
Generic
|
Brand Name
|
Pramlintide
|
Symlin
|
Sodium-Glucose Cotransporter 2 (SGLT-2) inhibitors
SGLT-2 inhibitors is a relatively new drug class for the
treatment of type 2 diabetes. SGLT-2 inhibitors block reabsorption of glucose
in the kidney. dThe mechanism of action is insulin independent.
Generic
|
Brand Name
|
Canagliflozin
|
Invokana
|
Dapagliflozin
|
Forxiga, Farxiga
|
Empagliflozin
|
Jardiance
|
SGLT-2
inhibitors under development
|
|
Ertugliflozin
|
|
Ipragliflozin
|
|
Remogliflozin etabonate
|
|
Tofogliflozin
|
|
Generic
|
Brand Name
|
Dopamine agonist
|
|
Bromocriptine
|
Parlodel, Cycloset
|
Bile acid
sequestrant
|
|
Colesevelam
|
Welchol, Cholestagel, Lodalis
|
Generic
|
Brand Name
|
Alogliptin + Metformin
|
Kazano
|
Dapagliflozin + Metformin
|
Xigduo XR
|
Glipizide + Metformin
|
Metaglip
|
Glyburide + Metformin
|
Glucovance
|
Linagliptin + Metformin
|
Jentadueto
|
Pioglitazone + Metformin
|
Actoplus Met, Actoplus Met XR
|
Repaglinide + Metformin
|
Prandimet
|
Rosiglitazone + Metformin
|
Avandamet
|
Saxagliptin + Metformin
|
Kombiglyze XR
|
Sitagliptin + Metformin
|
Janumet
|
Rosiglitazone + Glimepiride
|
Avandaryl
|
Pioglitazone + Glimepiride
|
Duetact
|
Alogliptin + Pioglitazone
|
Oseni
|
Simvastatin + Sitagliptin
|
Juvisync
|
Empagliflozin + Metformin
|
Synjardy
|
Resources
- 1. New FDA Approved Drugs CenterWatch
- 2. David A. Williams. Foye's Medicinal Chemistry. 7th Ed; LWW, 2012
- 3. Cho YM, Wideman RD, Kieffer TJ. Clinical application of glucagon-like Peptide 1 receptor agonists for the treatment of type 2 diabetes mellitus. Endocrinol Metab (Seoul). 2013 Dec;28(4):262-74. Full text
- 4. Rosenstock J, Balas B, Charbonnel B, Bolli GB, Boldrin M, Ratner R, Balena R; T-emerge 2 Study Group. The fate of taspoglutide, a weekly GLP-1 receptor agonist, versus twice-daily exenatide for type 2 diabetes. Diabetes Care. 2013 Mar. PubMed
- 5. Pattzi HM, Pitale S, Alpizar M, Bennett C, O'Farrell AM, Li J, Cherrington JM, Guler HP; PHX1149-PROT202 Study Group. Dutogliptin, a selective DPP4 inhibitor, improves glycaemic control in patients with type 2 diabetes: a 12-week, double-blind, randomized, placebo-controlled, multicentre trial. Diabetes Obes Metab. 2010 Apr;12(4):348-55. PubMed
- 6. Kim SH, Lee SH, Yim HJ. Gemigliptin, a novel dipeptidyl peptidase 4 inhibitor: first new anti-diabetic drug in the history of Korean pharmaceutical industry. Arch Pharm Res. 2013 Oct;36(10):1185-8. PubMed
