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Pharmacological Management of Type 2 Diabetes Using Oral Hypoglycaemic Agents and

Incretin-Based Agents and Nursing Applications

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Pharmacological Management of Type 2 Diabetes Using Oral Hypoglycaemic Agents and

Incretin-Based Agents and Nursing Applications

According to Meetoo et al. (2016), diabetes a chronic progressive life-long metabolic disorder

characterized by hyperglycaemia. Diabetes mellitus (DM) is a condition where there is a dysfunction of

production and secretion of insulin and the responsiveness of target cells’ to insulin is also present. It is a

common disease affecting the body of an individual to produce or utilize insulin. Type 2 diabetes (T2D)

is the most common form of DM accounting for approximately 95 percent of all cases and an individual’s

body cells becomes resistant to insulin effects. In response, insulin secretion is increased in the pancreas,

and over time beta cells are exhausted. T2D is an acquired health condition and lifestyle factors

increasing an individual’s risk include inactivity and poor diet. Reversing T2D is possible by engaging in

regular physical activity, moderating weight loss, and consuming a healthy diet. In instances when

controlling blood glucose level is difficult, oral diabetic medication is applied and implemented.

Management of Diabetes Type 2

Oral hypoglycaemic agents (OHAs) like dapagliflozine and the incretins are some of the drugs

used in the treatment of T2D. However, different OHAs are used and have different mechanisms of

action. First, sulfonylureas is a drug that helps in stimulating insulin secretion that results in increasing

responsiveness of ß-cells to both non-glucose and glucose secretagogues; thus, more insulin is released.

Additionally, the drug may have extra-pancreatic effects, such as increasing tissue sensitivity to insulin.

The second-generation sulfonylureas are glyburide, glipizide, and glimepiride (Bhattarai, 2018). The

common side effect of this drug is hypoglycemia including others like skin reactions, nausea, and
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abnormal liver function tests. The effectiveness of sulfonylureas is evident in patients with normal weight

or those slightly increased, but can also be used in underweight or those ketotic (Ganesan et al., 2021).

Secondly, metformin is the first-line of treating T2D that helps in preventing the liver from

responding to a lack of energy by increasing the body glucose production by driving higher the blood

glucose level (gluconeogenesis). Biguanide metformin is a class of medication with increasing hepatic

and muscle insulin sensitivity and decreases hepatic glucose production as its metabolism action that

reduces hyperglycaemia (Down, 2015). Metformin helps improve insulin sensitivity in an individual’s

skeletal muscle and is a monotherapy that remains as an only agent that has the potential for weight loss.

Additionally, combining metformin with sulfonylurea helps in lowering blood glucose concentrations.

The advantage of metformin is that it is less likely to cause hypoglycemia and has prominent lipid-

lowering activity. It should be taken with meals and avoiding intestinal side effects means it should be

started at a low dose. Gastrointestinal is the most common side effect of metformin that includes

abdominal discomfort, mild anorexia, a metallic taste in the mouth, and diarrhea.

Lastly, the GLP-1 receptor agonists is an incretin-based agent used in hyperglycaemia

management among T2D patients (Singh et al., 2017). The two GLP-1 receptor agonists available

currently are exenatide (Byetta) and liraglutide (Victoza). These agents have been well tolerated by

patients and have no safety concerns. These drugs are approved as monotherapy administered

subcutaneously an hour before meal times and are taken twice. Exenatide are most effective in blunting

post-prandial glycaemic excursions, induces weight loss, and improves lipid profiles. The side effects

include vomiting, nausea, and diarrhea.

Nursing Implications
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Treating diabetic patients requires nurses to obtain and document a thorough history of their

patient, vital signs, blood glucose levels (HbA1c levels), and the potential complications and drug

interactions before administering any drugs. The nurse should also assess the ability of the patient to

consume food and for nausea or vomiting to help in alter a patient’s glucose levels. The nurse should keep

in mind that for any diabetic patient, overall concerns increase when the patient has an infection, is under

stress, is pregnant or lactating, and has an illness. It is imperative for nurses to monitor blood glucose and

by administering OHAs, they help in stimulating beta cells in the pancreas for more insulin production

and help insulin work more effectively. The goals of nursing care for T2D is to minimize macrovascular

and microvascular complications. In the process, verbalize patients understanding of medical treatment

regimen, learn more about the disease and how it is managed, and side effects of medication. The

other nursing intervention for T2D patients is eating a balanced diet, engaging in exercise and physical

activity, maintaining appropriate blood sugar and maintain body weight to be within the normal range.

Conclusion

Diabetes type 2 is a global epidemic often associated with obesity and overweight Reduction of

long-term complications is possible by interventions that help patients achieve glucose levels that are

close to a normal range. Several OHAs, such as the use of sulfonylureas and metformin are available

pharmacological treatments of T2D, while GLP-1 receptor agonists are considered the best incretin-based

agent for this disorder. Other nursing interventions have been mentioned for treating T2D.
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References

Bhattarai, M. (2018). Principle of management of type 2 diabetes: From clinical, public health and

research perspectives. Diabetes and Its Complications, 7, 177.

https://www.intechopen.com/books/diabetes-and-its-complications/principle-of-management-of-

type-2-diabetes-from-clinical-public-health-and-research-perspectives

Down, S. (2015). Type 2 diabetes: prevention, diagnosis and management. Nursing times, 111(10), 14-15.

Ganesan, K., Rana, M. B. M., & Sultan, S. (Updated 2021, May 15). Oral hypoglycemic medications. In:

StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2021 Jan-. Available from:

https://www.ncbi.nlm.nih.gov/books/NBK482386/

Meetoo, D., Wong, L., & Alsomali, S. (2017). Pharmacological options for managing type 2 diabetes.

Nurse Prescribing, 14(7), 330-338.

https://www.researchgate.net/publication/

305111647_Pharmacological_options_for_managing_type_2_diabetes
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Singh, S., Wright Jr, E. E., Kwan, A. Y., Thompson, J. C., Syed, I. A., Korol, E. E., ... & Juneja, R.

(2017). Glucagon‐like peptide‐1 receptor agonists compared with basal insulins for the treatment

of type 2 diabetes mellitus: a systematic review and meta‐analysis. Diabetes, Obesity and

Metabolism, 19(2), 228-238.

https://dom-pubs.onlinelibrary.wiley.com/doi/full/10.1111/dom.12805