Introduction
Type 2 Diabetes is a kind of diabetes that is considered a chronic illness that needs pharmacological treatment. When used in the medical profession, drugs such as metformin and gliclazide are both often utilized in monotherapy. Despite this, the usage of these medications in combination was an attractive approach since their effects were complementary to one another. This study discusses the benefits and drawbacks of utilizing medicines to reduce glucose levels.
Action on Glucose-Lowering Therapy
Lowering blood glucose levels and raising insulin sensitivity is accomplished primarily by suppressing gluconeogenesis, competing with glucagon-mediated signaling in the liver, and, to a lesser extent, enhancing glucose uptake in skeletal muscle. These three mechanisms work together to achieve these two objectives. Metformin increases the translocation of GLUT-1 glucose transporters to the plasma membrane, which activates glucose absorption by stimulating the activation of the insulin receptor and insulin receptor substrate 2 (IRS-2) (Foretz et al., 2019).
As a result, the insulin-mediated reduction of gluconeogenesis that occurs during metformin administration is increased. Metformin also has an effect by inhibiting the gluconeogenic activity of the pancreas-produced hormone glucagon (Apovian et al., 2018). Metformin improves insulin sensitivity in skeletal muscle by boosting insulin receptor tyrosine kinase activity and GLUT-4 glucose transporter translocation to the plasma membrane. In order to produce this result, these two systems function in combination.
Furthermore, metformin increases AMPK activation, one of the insulin-induced mechanisms contributing to glucose absorption. Metformin’s efficacy in treating diabetes is associated with reduced insulin concentrations in the bloodstream. This finding supports the drug’s potential to increase glucose absorption in the liver and muscle tissue while decreasing gluconeogenesis and glucagon activities (Apovian et al., 2018). Metformin is a drug with a low risk of causing hypoglycemia, making it an intriguing therapy option for the elderly. Even if the presenting A1C is lower than the medication-treated target, healthy older adults can be treated the same way as younger adults by starting metformin treatment as soon as diabetes is diagnosed. However, elderly persons are more likely to have renal problems associated with aging; thus, metformin patients should exercise caution if they are elderly and taking the prescription.
In this case, the patient’s age of 72 years puts them in the same age bracket. Because the patient’s glucose level has stayed stable for the past nine years since the start of her medication treatment, new actions toward lowering the patient’s glucose level are required (Apovian et al., 2018). Changes in an older adult’s lifestyle, such as more excellent physical exercise, improved food, better blood sugar control, reduced alcohol intake, and quitting smoking, should be seriously considered. Participation in a diabetes prevention program can slow the progression from prediabetes to diabetes.
The optimum metformin and gliclazide dosages yield positive effects for the patient. As a result, a test is required to assess the patient’s current level of B12 and to treat it accordingly. Metformin is a common medication for type 2 diabetes. One of the potential side effects of metformin is a lack of B-12, which can raise a person’s risk of having a B-12 deficit if they already have diabetes (Owhin et al., 2019). If one has type 2 diabetes and a B12 deficiency, a B12 supplement may be beneficial. Metformin users with type 2 diabetes have been demonstrated to have lower vitamin B12 levels.
Metformin medication has been associated with B12 deficiency in people with type 2 diabetes, with a 10% increased risk of developing B12 deficiency. Metformin use and the risk of B12 deficiency increase as the dose and duration of metformin use increase (Kim et al., 2019). In this case, the patient has been taking medication to lower glucose levels for nine years, which is enough time for metformin to reduce vitamin B12 levels in the body. Metformin-induced vitamin B12 deficiency occurs when metformin interferes with the vitamin B12-intrinsic factor complex, resulting in decreased vitamin B12 absorption in the body (Kim et al., 2019).
Calcium is required for the receptors in our small intestines to absorb the B12-IF complex; however, this process cannot be completed without calcium. This condition is referred to as calcium dependency. Metformin is known to affect calcium-dependent activities, which can interfere with the absorption of the B12-IF complex (Kim et al., 2019). Diabetes patients may have difficulty with this.
Patients with worsening glycemic control on initial therapy with lifestyle intervention and metformin have the therapeutic option of adding a second oral or injectable agent, including adding insulin as an option or shifting to insulin. Both of these options are available to patients. The activity that must be done is ensuring that the patient has a well-balanced diet and takes all their medications appropriately. Another aspect to consider is making sure the patient consumes a sufficient amount of food at each mealtime to keep the glucose level at a stable level.
Pros of Metformin
Although concrete evidence from particular trials is still lacking, different study findings suggest that metformin may protect against comorbidities associated with diabetes and non-diabetes, such as cardiovascular, renal, neurological, and neoplastic illnesses. Metformin is frequently suggested as the first line of treatment for those who have just been diagnosed with type 2 diabetes. Numerous theories on how metformin exerts its preventive effects have been suggested over the last few decades, but none have been established beyond a reasonable doubt (Alsharidah et al., 2018). Nevertheless, it has been proven beyond a shadow of a doubt that metformin raises lactate levels, production, and, very possibly, oxidation.
The transfer of energy from the places of production to the regions where it is needed, however, has been demonstrated by recent studies to play a substantial part in this process. All end organs can be immediately supplied with energy by skipping glycolysis and its possible byproducts. Instead, they acquire total energy through the direct absorption and oxidation of lactate generated elsewhere. Therefore, the enhanced lactate production caused by metformin might be seen as a positive mode of action. The likelihood of lactic acidosis increases when metformin and lactate levels cross specific thresholds.
Cons of Metformin
Like many drugs, metformin can potentially have side effects ranging from being utterly innocuous to fatal. The most common adverse side effects are nausea, vomiting, diarrhea, lightheadedness, and a metallic taste in the mouth. These signs and symptoms are linked to digestive tract problems. Due to additional factors that may enhance their chance of developing such side effects, senior people may generally be at a greater risk of its adverse effects, such as lactic acidosis or low blood sugar (Alsharidah et al., 2018). Gastrointestinal function disturbances are one of the less serious side effects. People report experiencing most frequently anorexia, nausea, stomach pain, and diarrhea (Li et al., 2021). It is conceivable that decreasing the dosage or quitting the medication can help to alleviate or lessen these effects. Lactic acidosis and a deficiency of vitamin B12 are the two main side effects.
Pros of Gliclazide
Type 2 diabetes is treated with the diabetes drug gliclazide. It encourages the pancreas to produce more insulin, lowering blood glucose levels. In diabetes, accelerated atherosclerosis, vascular alterations, and prothrombotic microangiopathic changes can all be attributed to advanced glycosylation end products (AGEs) and free radicals produced during this process (Khunti et al., 2020). The amount of hyperglycemia and its duration are influenced by the rate of free radical production, which is influenced by the rate of protein glycosylation. The processes of oxidation and glycation are inextricably linked (Khunti et al., 2020). Since free radicals and their reaction products, lipid peroxides, are known to cause endothelial cell damage, lipoprotein oxidation, platelet reactivity modification, and the arachidonic acid cascade, an increase in oxidative stress caused by an excess of free radical activity may be at the root of diabetic vascular disease.
The discovery of the mechanism by which hyperglycemia leads to vascular damage is critical because it opens up the possibility of scavenging free radicals, which will have implications apart from improving diabetes treatment. Gliclazide has been shown in studies over the last 15 years to lower blood glucose levels and improve the hemorrhageologic abnormalities associated with diabetic vascular disease (Hassanein et al., 2020). Gliclazide has been proven in clinical investigations to reduce platelet reactivity while increasing endothelial prostacyclin production (Hassanein et al., 2020). It has also been demonstrated to promote fibrinolysis via its effects on tissue plasminogen activators.
In clinical studies, the beneficial effects of gliclazide on platelets have been linked to a reduction in oxidative stress. This property is due to gliclazide’s ability to scavenge free radicals, which is linked to the one-of-a-kind aminoazabicyclo-octane ring grafted onto the sulfonylurea. The gliclazide preparation with the modified release is in charge of its entire upkeep. As a result, in diabetes, where increased glycation and oxidation play an essential role in the pathogenesis of diabetic vascular disease, drugs like gliclazide, recognized for its antioxidant qualities, may have a broader therapeutic effect due to their potential involvement.
Gliclazide can be taken by itself or with other medications, in addition to a healthy diet and consistent physical activity. The actions of gliclazide on tissue plasminogen activator leads to an increase in fibrinolysis and a decrease in platelet reactivity (Alsharidah et al., 2018). These effects, which have been observed in vitro and in vivo, are not related to the regulation of glucose levels and are not observed with other sulfonylureas.
The ability of gliclazide to scavenge free radicals is what underlies this trait (Seidu et al., 2021). This ability is related to the one-of-a-kind aminoazabicyclo-octane ring grafted onto the sulfonylurea (Seidu et al., 2021). Therefore, in diabetes, where increased glycation and oxidation play a vital part in the pathogenesis of the diabetic vascular disease, medicines such as gliclazide, known for its antioxidant activity, may have an improved therapeutic function due to the potential benefits they offer.
Sulfonylurea medications appear to improve exogenous insulin sensitivity in people with type 2 diabetes who have lapses in glycemic control. These agents accomplish this by lowering the patient’s daily insulin dose. Moreover, glimepiride appears superior to other sulfonylureas in its ability to lower insulin requirements. It is estimated that 90% of patients can safely transition from insulin to oral sulfonylureas with excellent initial glycemic control; however, whether or not this control is maintained long-term is unknown (Sanz-Cánovas et al., 2022). After five years of treatment, approximately 44% of people with type 2 diabetes fail to respond to sulfonylureas.
Cons of Gliclazide
Liclazide has the potential to occasionally cause dangerously low blood sugar levels. When too much gliclazide is ingested, it happens. The following side effects were reported by at least one percent of individuals who used this medication: Numerous of these negative effects may be reduced, and some even disappear on their own (Alsharidah et al., 2018). Other possible side effects of gliclazide include nausea, vomiting, diarrhea, headache, heartburn, soreness in the back, muscles, or joints, incontinence, diarrhea, disorientation, and headaches.
A HbA1c Target
An individual’s objective for their HbA1c level should be determined through discussion with their doctor. On the other hand, it seems that a level of roughly 7% (53 mmol/mol) is an acceptable compromise for the great majority of people with type 2 diabetes. Consequently, it is essential to make efforts toward lowering it to a lower level. Since this is the ideal range, patients with diabetes should strive for an HbA1c level of 48 mmol/mol or below (below 6.5%). When an adult patient is being treated with a medicine that has the potential to produce hypoglycemia, the treating physician should advise the patient to work toward achieving an HbA1c level of 53 mmol/mol (7%). (Saeed et al., 2018). The patient’s HbA1c level is 55 mmol/mol, which is 7.5%; as a result, for the therapy to be successful, she will need to make slow progress toward reducing it and then continue to keep it at that level.
Conclusion
Diabetes drugs, particularly those used to treat type 2 diabetes, can have beneficial and adverse effects on the patient. To obtain the best benefit from their prescription, the patients in the case should pay attention to her meals’ timing and her diets. This will enable her to get the most out of their treatment. Furthermore, there are a variety of additional helpful therapeutic strategies, such as losing weight by exercising more regularly.
Reference List
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