Testing
HbA1c
Drug Treatment of Diabetes Mellitus
| Classification | Classification | Clasification | Members | Adult Dose | Pediatric Dose | Renal Dosing | Mechanism of Action | Side Effects |
|---|---|---|---|---|---|---|---|---|
| α-Glucosidase Inhibitors | Acarbose | 25 mg three times daily before meals, titrated up to 100 mg three times daily | Indication: Type 2 diabetes, used as adjunct therapy to diet and exercise. Initial dose: 25 mg three times a day with meals for children ≥ 10 years old. Titration: Increase by 25 mg every 1–2 weeks based on clinical response. Maximum dose: 100 mg three times a day | No dose adjustment needed | slow the breakdown of starches in the intestines, which helps prevent blood sugar spikes after meals | Gastrointestinal issues: Gas, bloating, and diarrhea. Liver enzyme abnormalities: Rare but possible | ||
| Meglitol | ||||||||
| Insulin Sensitizers | Biguanides | Metformin | Initial dose: 500 mg BID or 850 mg once daily. Maintenance dose: 500 mg to 2000 mg daily, in divided doses | Indication: Type 2 diabetes (usually in combination with diet and exercise) Initial dose: 500 mg once or twice daily Titration: Increase by 500 mg weekly (or every 2 weeks) to minimize gastrointestinal side effects. Maximum dose: 2000–2500 mg/day (based on tolerance and clinical judgment). Notes: Doses greater than 2000 mg/day may be used in older children (16+), but safety and efficacy beyond this dose are not well-established in younger children. | CrCl > 60 mL/min: No dose adjustment needed. CrCl 45-59 mL/min: No dose adjustment needed. CrCl 30-44 mL/min: Reduce dose to half. CrCl < 30 mL/min: Metformin is generally contraindicated due to the risk of lactic acidosis. | This is often the first-line treatment for type 2 diabetes. It works by reducing the amount of glucose produced by the liver and improving the body's response to insulin | Gastrointestinal issues: Nausea, diarrhea, stomach pain, and bloating. Vitamin B12 deficiency: Long-term use may lead to lower levels of vitamin B12 | |
| Thiazolidinediones (Glitazones) | Pioglitazone | 15-30 mg daily | Indication: Type 2 diabetes (used infrequently in children). Dose: Not widely used in pediatrics; however, a typical adult dose of pioglitazone is 15–45 mg/day, adjusted based on clinical judgment and patient tolerance. Caution: There is limited pediatric data on the safety and long-term use of thiazolidinediones. | No dose adjustment needed | Improve insulin sensitivity in muscle and fat cells. They can cause weight gain and fluid retention. | Weight gain: Can cause significant weight gain. Fluid retention: Leading to swelling and an increased risk of heart failure. Bone fractures: Higher risk of fractures, particularly in women | ||
| Rosiglitazone | 4-8 mg daily | Use with caution | ||||||
| Insulin Secretagogues | Sulfonylureas | First Generation | Acetohexamide | Stimulate the pancreas to produce more insulin | Hypoglycemia: Low blood sugar levels can occur, especially if meals are skipped. Weight gain: These medications can lead to an increase in weight. Skin reactions: Rashes or itching may occur | |||
| Carbutamide | ||||||||
| Chlorpropamide | CrCl < 50 mL/min: Avoid use | |||||||
| Glycyclamide | ||||||||
| Metahexamide | ||||||||
| Tolbutamide | ||||||||
| Tolazamide | ||||||||
| Second Generation | Glibizide | 5 mg daily, titrated up to 40 mg daily | Initial dose: 2.5–5 mg/day for children ≥ 10 years old. Titration: Increase by 2.5–5 mg every 1–2 weeks based on clinical response. Maximum dose: 20 mg/day (typically lower doses are used in pediatric patients) | CrCl > 60 mL/min: No dose adjustment needed. CrCl 30-59 mL/min: Reduce dose by 50% CrCl < 30 mL/min: Use with caution; consider switching to insulin | ||||
| Glibornuride | ||||||||
| Gliclazide | Mild renal impairment (creatinine clearance >30 mL/min): The usual dose can be used with caution. Severe renal impairment: Should be avoided, or dose reduced. | |||||||
| Gliquidone | ||||||||
| Glisoxebide | ||||||||
| Glyburide (Glibenclamide) | 1.25-5 mg daily, titrated up to 20 mg daily | Not recommended | CrCl > 60 mL/min: No dose adjustment needed. CrCl 30-59 mL/min: Reduce dose by 50% CrCl < 30 mL/min: Glyburide is generally avoided due to the risk of prolonged hypoglycemia | |||||
| Third Generation | Glimepiride | Initial dose: 1–2 mg/day for children ≥ 10 years old. Titration: Increase every 1–2 weeks based on blood glucose response. Maximum dose: 4 mg/day | CrCl > 60 mL/min: No dose adjustment needed CrCl 30-59 mL/min: Reduce dose by 50% CrCl < 30 mL/min: Use with caution; consider switching to insulin | |||||
| Meglitinides | Repaglinide | 0.5 mg before each meal, titrated up to 4 mg before each meal | CrCl > 60 mL/min: No dose adjustment needed. CrCl 30-59 mL/min: Reduce dose by 50%. CrCl < 30 mL/min: Use with caution; consider switching to insulin | Similar to sulfonylureas, these drugs, stimulate insulin release but are taken with meals to reduce the risk of hypoglycemia | Hypoglycemia: Similar to sulfonylureas, these can cause low blood sugar levels. Weight gain: Less common but can occur | |||
| Mitiglinide | ||||||||
| Nateglinide | 60 mg before each meal, titrated up to 120 mg before each meal | CrCl > 60 mL/min: No dose adjustment needed CrCl 30-59 mL/min: Reduce dose by 50% CrCl < 30 mL/min: Use with caution; consider switching to insulin | ||||||
| SGLT2 Inhibitors (Gliflozins) | Canagliflozin | 100 mg daily | not approved for use in children under 18, but may be considered under specialized care in some cases, based on adult data | CrCl < 45 mL/min: Use with caution. Canagliflozin and dapagliflozin are not recommended for initiation at CrCl < 45 mL/min | work by preventing the kidneys from reabsorbing glucose, leading to its excretion in urine | Yeast infections: Both genital and urinary tract yeast infections. Dehydration: Leading to dizziness or low blood pressure. Ketoacidosis: A rare but serious condition with high blood ketone levels. Lower limb amputations: Increased risk, particularly with canagliflozin | ||
| Empagliflozin | Approved for children aged 10-18 years. The dose is typically 2.5-10 mg daily, depending on the child's needs and response to treatment | |||||||
| Dapagliflozin | 5 mg daily, titrated up to 10 mg daily | |||||||
| Ertugliflozin | ||||||||
| Incretin Mimetics (Peptide Analogs) DPP4-Inhibitors (GLIPTINS) | Alogliptin | mimic the action of incretin hormones, which increase insulin release and decrease glucagon levels | Upper respiratory tract infections: Symptoms like a runny nose and sore throat. Joint pain: Some people may experience joint pain. Pancreatitis: Rare but serious inflammation of the pancreas. | |||||
| Anagliptin | ||||||||
| Linagliptin | ||||||||
| Saxagliptin | 2.5-5 mg daily | 2.5 mg daily for CrCl 30-59 mL/min; avoid use if CrCl < 15 mL/min. | ||||||
| Sitagliptin | 100 mg daily | Indication: Type 2 diabetes in children ≥10 years old. Initial dose: 100 mg once daily. Notes: Doses may need adjustment in children with renal impairment | 50 mg daily for CrCl 30-59 mL/min; 25 mg daily for CrCl 15-29 mL/min | |||||
| Tenegliptin |