The commonly used antidiabetic drugs are divided into eight types according to the mechanism of action, mainly including insulin and its analogues, sulfonylurea secretagogues, metformin α- Glucosidase inhibitor, thiazolidinedione derivative sensitizer, phenylanisic acid derivative secretion promoter, GLP-1 receptor agonist, DPP-4 enzyme inhibitor and Chinese patent medicine.
Diabetes is a kind of chronic comprehensive disease mainly caused by the absolute or relative deficiency of insulin or the reduction of insulin sensitivity by target cells. The occurrence of type 2 diabetes is peripheral insulin resistance. β The result of the joint action of cell function defects. When diabetic patients are treated with diet and exercise therapy and diabetes health education, the control of blood sugar still can not reach the treatment target, and they should be treated with drugs. Hypoglycemic chemicals can be roughly divided into oral hypoglycemic drugs and injection hypoglycemic drugs
Types of chemical hypoglycemic drugs
Insulin secretagogue is an alternative first-line hypoglycemic drug, which includes sulfonylureas and non sulfonylureas. It mainly plays a role by promoting insulin secretion, inhibiting ATP dependent potassium channel and making K + outflow, β Cell depolarization, Ca2 + influx, induced insulin secretion. In addition, it can also strengthen the binding between insulin and its receptor, relieve the effect of insulin resistance after receptor, and strengthen the effect of insulin.
（1） Glipizide (mepida, ruiyining, Desa, epida and youdaling): it is the second generation of sulfonylurea drugs, with fast onset and lasting effect in human body for 6-8 hours. It is particularly effective in reducing postprandial hyperglycemia; Because its metabolites are inactive and excreted rapidly, it causes less hypoglycemic reaction than glibenclamide, and is suitable for elderly patients.
（2） Gliclazide (damikang): it is the second generation of sulfonylurea, and its efficacy is more than 10 times stronger than that of the first generation of tolbutamide; In addition, it also inhibits platelet adhesion and aggregation, which can effectively prevent microthrombosis and thus prevent microangiopathy in type 2 diabetes. It is suitable for adults with type 2 diabetes, type 2 diabetes, obesity or vasculopathy. Use with caution for the elderly and those with decreased renal function.
（3） Glibenclamide (glibenclamide): it is the second generation of sulfonylureas. It has the strongest hypoglycemic effect among all sulfonylureas, 200-500 times that of tolbutamide, and its effect can last for 24 hours. It can be used for mild to moderate non insulin dependent type 2 diabetes, but it is prone to hypoglycemia. Elderly and renal insufficiency should be used with caution.
（4） Glibenclamide (ketolide): 20 times stronger than the first generation tolbutamide, easier to absorb and less hypoglycemia than glibenclamide; Its effect lasts 24 hours. It can be used for non-insulin-dependent diabetes mellitus type 2.
（5） Glimepiride (amoride): it is the third generation of oral sulfonylureas. Its mechanism of action is the same as that of other sulfonylureas, but it can increase the intake of cardiac glucose in a way unrelated to insulin, and has less impact on the cardiovascular system than other oral hypoglycemic drugs; Its half-life in vivo can be as long as 9 hours and only needs to be taken orally once a day. It is suitable for non-insulin-dependent diabetes mellitus type 2.
（6） Gliquidone (glucose equality): the second generation of oral sulfonylurea hypoglycemic drugs, which is highly active Pro islet β Cytokines, and islets β Specific receptor binding on cell membrane can induce the production of appropriate amount of insulin to reduce blood glucose concentration. After oral administration of this product for 2 ~ 2.5 hours, it reaches the maximum blood concentration and is fully absorbed soon. The plasma half-life is 1.5 hours, and the metabolism is complete. Its metabolites do not have hypoglycemic effect, and most of the metabolites are excreted through the biliary digestive system. It is suitable for mild to moderate non insulin dependent type 2 diabetes patients who are not satisfied with the effect of diet control, and the islet B cells have certain insulin secretion function and no serious complications.
The above are commonly used sulfonylurea hypoglycemic drugs, and the order of hypoglycemic intensity from strong to weak is glibenclamide > glipizide > Gliquidone > gliclazide.