<prompt> A alpha-glucosidase inhibitor is?PioglitazoneMaglitolMetforminNateglinide  <response>: Ans. b Maglitol Ref. Harrison medicine 17th ed. Table 383-11; KD Tripathi, Pharmacology, 5th ed., 252ORAL HYPOGLYCEMICS Sulfonylureas : Tolbutamide, chlorpropamide, glibenclamide, glipizide, gliclazide, glimepiride Biguanides : Phenformin and metformin. Meglitinide analogues : Repaglinide, nateglinide Thiazolidinediones : Rosiglitazone, pioglitazone. Alpha-glucosidase inhibitor : maglitol, acarbose.GLUCOSE-LOWERING THERAPIES FOR TYPE 2 DIABETESClass of anti-diabetic and ExamplesMechanism of ActionAgent-Specific AdvantagesAgent-Specific DisadvantagesContraindications Relative ContraindicationsORALBiguanidesMetforminHepatic glucose production, weight loss, glucose, utilization, insulin resistanceWeight lossLactic acidosis, diarrhea, nauseaSerum creatinine 1.5 mgdL men 1.4 mgdL women, CHF, radiographic contrast studies, seriously ill patients, acidosisalpha-Glucosidase inhibitorsAcarbose, MaglitolGlucose absorptionReduce postprandial glycemiaGl flatulence, liver function testsRenalliver diseaseDipeptidyl peptidase IV inhibitorsSitagliptinProlong endogenous GLP-1 actionDoes not cause hypoglycemia Reduce dose with renal diseaseInsulin secretagogues-- Sulfonylurea-first generation: Chlorpropamide, Tolazamide, Tolbutamide Sulfonylurea--second generation: Glimepiride, Glipizide, Glipizide extended release, Glyburide, Glyburide micronizedInsulin secretionLower fasting blood glucoseHypoglycemia, weight gainRenal liver diseaseInsulin secretagogues-- nonsulfonylureasRepaglinideNateglinide Insulin secretionShort onset of action, lowers postprandial glucoseHypoglycemiaRenal liver diseaseThiazolidinedionesRosiglitazone,Pioglitazone Insulin resistance, glucose utilizationLower insulin requirementsPeripheral edema, CHF, weight gain, fractures, macular edema; rosiglitazon may increase risk of MlCongestive heart failure, liver diseasePARENTERALInsulinShort-acting,subcutaneousLispro, AspartGlulisine, Regular Glucose utilization and other anabolic actionsKnown safety profileInjection, weight gain, hypoglycemia Short-acting, inhaledInhaled regular insulinLong-actingNPH, Detemir,Glargine GLP-1 agonistExenatide Insulin, Glucagon, slow gastric emptyingWeight lossInjection, nausea, risk of hypoglycemia with insulin secretagoguesRenal disease, agents that also slow GI motilityAmylin agonistPramlintideSlow gastric emptying, GlucagonReduce postprandial glycemia, weight lossinjection, nausea, ?risk of hypogly- cemia with insulinAgents that also slow GI motilityMedical nutrition therapy and physical activityLow-calorie, low-fat diet, exercise Insulin, resistance, insulin secretionOther health benefitsCompliance difficult, long-term success low 