Minimizing the risk of hypoglycemia in patients with type 2 diabetes mellitus

Figures & data

Figure 1 Hypoglycemia: Critical point of care in diabetes management.⁷ Copyright 2006. Reprinted with permission from the American Diabetes Association, Briscoe VJ, Davis SN. Hypoglycemia in type 1 and type 2 diabetes: Physiology, pathophysiology and management. Clin Diabetes. 2006;24:115–121.

Notes: ^ammol/L × 18 = mg/dL; ^bCaused by falling glucose levels; ^cCaused by brain neuronal glucose deprivation.

Table 1 Antihyperglycemic medications for type 2 diabetes mellitus¹⁸

Intervention	Main effects	Hypoglycemic risk
α-Glucosidase inhibitor	Reduces rate of polysaccharide digestion in the proximal small intestine	Low
Amylin agonist	Slows gastric emptying and inhibits glucagon production	Low
DPP-4 inhibitor	Enhances effects of GLP-1 and GIP; increases glucose-mediated insulin secretion and suppresses glucagon secretion	Low
Glinide	Stimulates insulin secretion	Higha
GLP-1 agonist	Potentiates glucose-stimulated insulin secretion	Low
Insulin	Insulin replacement	High
Metformin	Decreases hepatic glucose output	Low
Sulfonylurea	Enhances insulin secretion	High
Thiazolidinedione	Increases sensitivity of muscle, fat, and liver to endogenous and exogenous insulin	Low

a Notes: May be less frequent with nateglinide.

Abbreviations: DPP-4, dipeptidyl peptidase-4; GIP, glucose-dependent insulinotropic polypeptide; GLP-1, glucagon-like peptide-1.

Briscoe VJ Davis SN Hypoglycemia in type 1 and type 2 diabetes: Physiology, pathophysiology and management Clin Diabetes 2006 24 115 121

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Nathan DM Buse JB Davidson MB Medical management of hyperglycemia in type 2 diabetes: A consensus algorithm for the initiation and adjustment of therapy: A consensus statement of the American Diabetes Association and the European Association for the Study of Diabetes Diabetes Care 2009 32 193 203 18945920

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