Abstract
Diabetes mellitus (DM) prevalence is reported as high as 10% in the general population and is even higher in those with mental illness. An elevated blood sugar is seen in almost 20% patients with serious mental illness [1]. The cutoffs for accepted and commonly used measures to diagnose DM are shown in the section on diagnosis later.
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Appendix
Appendix
Currently available noninsulin medication classes for diabetes mellitus
Medication class | Mechanism of action | Comments |
|---|---|---|
Biguanides (metformin) | Reduces glucose production from liver and increases sensitivity to insulin | Low risk of hypoglycemia Can be used if glomerular filtration rate (GFR) >30 mL/min Vitamin B12 should be monitored periodically |
Sulfonylureas (e.g., glipizide) | Increase insulin secretion | Increased risk of hypoglycemia Risk of weight gain |
Dipeptidyl peptidase 4 (DDP-4) inhibitors (e.g., sitagliptin, saxagliptin) | Stimulate insulin synthesis and secretion and suppress glucagon secretion | Weight neutral Low risk for hypoglycemia |
Thiazolidinediones (e.g., rosiglitazone, pioglitazone) | Reduce glucose secretion and reduce insulin resistance | Risk of weight gain Side effect of chronic edema and heart failure Increased risk of bone fractures |
Glucagon-like peptide (GLP-1) agonists (e.g., liraglutide, exenatide) | Increase glucose-dependent insulin secretion | Low risk of hypoglycemia Advantage of weight loss Should not be used if history of medullary thyroid cancer Use with caution if history of pancreatitis Not orally available |
Sodium glucose cotransporter 2 (SGLT-2) inhibitors (e.g., canagliflozin, empagliflozin) | Promote renal excretion of glucose | Increased risk of genital fungal infections Associated with diabetic ketoacidosis Not effective at GFR<45 mL/min |
Meglitinides (e.g., repaglinide) | Increase insulin secretion | Some risk of hypoglycemia Risk of weight gain |
Alpha-glucosidase inhibitors (e.g., acarbose) | Reduce postprandial glucose by preventing carbohydrate breakdown | Use limited by side effects of bloating, flatulence, diarrhea |
Bile acid sequestrant (e.g., colesevelam) | May reduce intestinal glucose absorption | Use limited by side effect of constipation, dyspepsia |
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Annamalai, A. (2017). Diabetes Mellitus and Acute Hyperglycemia. In: Medical Management of Psychotropic Side Effects. Springer, Cham. https://doi.org/10.1007/978-3-319-51026-2_3
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DOI: https://doi.org/10.1007/978-3-319-51026-2_3
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