28.3 Oral Antidiabetic Drugs

Oral antidiabetic drugs are crucial in managing type 2 diabetes. They work in various ways to control blood sugar levels, from increasing insulin sensitivity to slowing carb absorption. Each type has its own benefits and potential side effects.

Nurses play a key role in administering these meds and educating patients. They monitor blood sugar, watch for side effects, and teach patients about proper use. Helping patients understand their meds and make lifestyle changes is essential for effective diabetes management.

Oral Antidiabetic Drugs

Types and mechanisms of action

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• Biguanides (metformin) decrease hepatic glucose production, increase insulin sensitivity in peripheral tissues (muscles), and enhance glucose uptake and utilization by muscles
• Sulfonylureas (glipizide, glyburide) stimulate pancreatic beta cells to release insulin and increase insulin secretion
• Meglitinides (repaglinide, nateglinide) are rapid-acting, short-duration insulin secretagogues that stimulate pancreatic beta cells to release insulin
• Thiazolidinediones (pioglitazone, rosiglitazone) increase insulin sensitivity in peripheral tissues (muscles and adipose tissue), enhance glucose uptake and utilization, and decrease hepatic glucose production
• Alpha-glucosidase inhibitors (acarbose, miglitol) slow the breakdown and absorption of carbohydrates in the intestine, reducing postprandial glucose levels
• Dipeptidyl peptidase-4 (DPP-4) inhibitors (sitagliptin, linagliptin) increase incretin hormone levels (GLP-1 and GIP), enhance glucose-dependent insulin secretion, and suppress glucagon secretion
• Sodium-glucose cotransporter 2 (SGLT2) inhibitors (canagliflozin, dapagliflozin) block glucose reabsorption in the kidney, increase urinary glucose excretion, and reduce blood glucose levels independently of insulin

Indications, side effects, and contraindications

• Metformin: First-line treatment for type 2 diabetes, especially in overweight or obese patients; may cause gastrointestinal disturbances (diarrhea, nausea, abdominal discomfort) and vitamin B12 deficiency; contraindicated in severe renal impairment, metabolic acidosis, acute or chronic metabolic acidosis, and hypersensitivity
• Sulfonylureas: Used when metformin alone is insufficient or contraindicated in type 2 diabetes; may cause hypoglycemia and weight gain; contraindicated in type 1 diabetes, diabetic ketoacidosis, severe renal or hepatic impairment, and hypersensitivity
• Thiazolidinediones: Often used in combination with other antidiabetic agents in type 2 diabetes; may cause weight gain, fluid retention, increased risk of heart failure, and increased risk of fractures; contraindicated in heart failure, hepatic impairment, and hypersensitivity
• DPP-4 inhibitors: Often used in combination with other antidiabetic agents in type 2 diabetes; may cause headache, nasopharyngitis, and upper respiratory tract infections; contraindicated in type 1 diabetes, diabetic ketoacidosis, and hypersensitivity
• SGLT2 inhibitors: Often used in combination with other antidiabetic agents in type 2 diabetes; may cause genital mycotic infections, urinary tract infections, hypotension, and increased LDL cholesterol; contraindicated in type 1 diabetes, diabetic ketoacidosis, severe renal impairment, and hypersensitivity

Nursing considerations

• Assess patient's blood glucose levels regularly, monitoring for signs and symptoms of hypoglycemia (shakiness, dizziness, sweating) or hyperglycemia (increased thirst, frequent urination, blurred vision); adjust medication doses as needed based on blood glucose readings and healthcare provider's orders
• Administer medications at prescribed times and doses, ensuring proper timing in relation to meals; educate patients on the importance of adherence to medication regimens
• Monitor for adverse effects (gastrointestinal disturbances, hypoglycemia, weight changes) and drug interactions with other medications, herbal supplements, or over-the-counter products
• Adjust medication administration based on patient factors, considering renal and hepatic function; use caution in patients with comorbidities such as heart failure or renal impairment
• Collaborate with the healthcare team, communicating patient's response to therapy, adverse effects, and any concerns to the prescriber; work with dietitians and diabetes educators to provide comprehensive patient care and education

Patient education

• Emphasize the importance of regular blood glucose monitoring; teach patients how to use a glucometer, interpret results, and when to contact their healthcare provider based on readings
• Provide education on proper medication administration, including correct timing, dose, and route; emphasize the importance of not skipping or doubling doses without consulting their healthcare provider
• Discuss potential side effects (gastrointestinal disturbances, hypoglycemia) and how to manage them; provide strategies for managing side effects, such as taking medications with food
• Encourage a healthy lifestyle, emphasizing the importance of a balanced diet, regular exercise (walking, swimming), and maintaining a healthy weight; explain how lifestyle modifications can improve blood glucose control and overall health
• Stress the importance of regular follow-up appointments; encourage patients to attend scheduled appointments and discuss any concerns, questions, or changes in their condition with their provider
• Educate on hypoglycemia prevention and treatment; teach patients the signs and symptoms of hypoglycemia (confusion, shakiness, sweating) and provide guidance on how to prevent and treat hypoglycemic episodes, including carrying fast-acting carbohydrates (glucose tablets, fruit juice)
• Emphasize the importance of foot care and regular eye exams; educate patients on proper foot care techniques (daily inspections, wearing well-fitting shoes) and encourage them to attend regular eye exams to screen for diabetic retinopathy