Currently Used Anti-diabetic Medications and Use in Relationship to Bariatric Surgery (Kashyap et al.)
The most popular drug in this group is metformin, which increases insulin sensitivity by suppressing hepatic gluconeogenesis and opposition of glucagon action . It has been quite popular with bariatric physicians for its ability to promote weight loss. It is important to know that the bioavailability is increased post bariatric surgery, the dosages need to be adjusted cautiously .
Also called the proliferator-activated receptor (PPAR) agonists or glitazones, this works primarily by increasing the insulin sensitivity. But since the mechanism of action is by reducing the visceral fat and increasing the subcutaneous fat, is known to promote weight gain. Hence could be used as a second line therapy to metformin for residual T2DM .
Unlike metformin and thiazolidinediones, sulfonyl ureas enhance insulin secretion by direct action on beta cells . Hence it carries a higher risk of inducing hypoglycemia and weight regain [17, 18]. It has also been shown to carry higher risk of inducing hyperinsulinemic hypoglycemia and symptoms of dumping syndrome
. Hence it has to be used cautiously and can be considered as option for treatment of T2DM in the background of poor beta cell function and also to prevent further beta cell failure, along with an insulin sensitizing agent.