25.11 : 経口血糖降下剤：ビグアナイドおよびグリタゾン

Biguanides are insulin sensitizers that enhance glucose uptake, reducing insulin resistance.

Unlike sulfonylureas, they do not stimulate insulin secretion, mitigating hypoglycemic risk.

They decrease hepatic gluconeogenesis, a prevalent source of high blood glucose in type 2 diabetes.

It also slows intestinal sugar absorption, boosts peripheral glucose uptake, and causes loss of appetite, potentially inducing weight loss.

Metformin is the drug of choice for type 2 diabetes. However, its usage requires careful dosage adjustments and is contraindicated in cases of renal dysfunction and acute myocardial infarction or heart failure.

Thiazolidinediones represent another class of insulin sensitizers. They are used alone or combined with other oral hypoglycemics or insulin.

Thiazolidinediones function as PPARγ receptor agonists, lowering insulin resistance.

Pioglitazone is recommended as a second or third-line agent for type 2 diabetes, while rosiglitazone's use is limited due to potential cardiovascular risks.

Their adverse effects include weight gain, edema, osteopenia, and increased fracture risk in women.