Effects of Anti-diabetic drugs in the Management Of Diabetes Mellitus Discussion

Effects of Anti-diabetic drugs in the Management Of Diabetes Mellitus Discussion

For this assignment, you will write a paper on the pharmacological management of the disease. The paper should include:

A review of the selected disease process that is of interest to you.
A/An review/overview of the pathophysiology of the disease state.
A review of the pharmacological agents used for treatment and important information related to advanced practice nurse.
The title of your paper must be in the format of the following sample. Sample title: “Pharmacological Effects of Anti-Hypertensive Medications in the Management of Hypertension”.

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The paper is to be clear and concise and students will lose points for improper grammar, punctuation, and misspelling.
The paper should be formatted per current APA and 5-7 pages in length, excluding the title, abstract and references page.
Incorporate a minimum of 5 current (published within last five years) scholarly journal articles or primary legal sources (statutes, court opinions) within your work Effects of Anti-diabetic drugs in the Management Of Diabetes Mellitus Discussion.

Introduction

As an advanced practice nurse, it is important to understand the pharmacological aspect of disease management to enable one achieve optimum patient-oriented care, based on what drug therapy works best for each patient. In order to use these pharmacological agents safely for disease management, one should be able to understand the mechanism of action of the various drugs for the selected disease processes as well as their adverse effects on the patient for drug monitoring. In this paper, the author discusses the pharmacological effects of drugs used in the management of diabetes mellitus.

A Review of Diabetes Mellitus

Diabetes mellitus is a metabolic disorder affecting the ability of the pancreas to secrete insulin in the body. Insulin is an important hormone, which regulates the body’s metabolism of glucose hence regulating blood sugar levels. Without enough insulin, as in the case of diabetes mellitus type 1, the body’s ability to utilize glucose for energy is compromised, leading to dangerously high levels of glucose in the blood. Hyperglycemia results in the symptoms of diabetes Effects of Anti-diabetic drugs in the Management Of Diabetes Mellitus Discussion.

There are different classifications of diabetes mellitus including type 1 DM, type 2 DM, and maturity onset diabetes of the young (MODY). The major subtypes of great concern are type 1 and type 2 diabetes mellitus. In type 1 DM, there is a defect in the insulin secreting cells in the pancreas. As a result, the body has either extremely low levels of insulin or no insulin at all. Consequently, these individuals cannot metabolize glucose at all and require exogenous insulin administration to survive. Type 1 DM typically affects younger people and begins in childhood, before the age of forty (Weinstock & Lucier, 2020).

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In type 2 DM, there is an imbalance between insulin levels being produced and insulin sensitivity. It is mainly due to insulin resistance and is commonly associated with obesity and old age (occurs after the age of forty). These patients can usually benefit from drugs that stimulate insulin secretion by the pancreas.

According to the centers for Disease Control and Prevention (CDC) on National Diabetes Statistics Report, approximately more than 130 million adults in the United States are living with diabetes or prediabetes states. The National Diabetes Statistics Report for 2020 reports that 34.2 million people of all ages had diabetes in 2018 (“National Diabetes statistics report, 2020,” 2020)Effects of Anti-diabetic drugs in the Management Of Diabetes Mellitus Discussion. This corresponds to 10.5% of the U.S population. Among these, 34.1 million were adults above the age of 18. The percentage of adults with diabetes increased with age. This study also found the prevalence to be higher in men compared to women, and higher in American Indians and African Americans as compared to the other races.

Among those diagnosed with diabetes at older ages, risk factors such as smoking, being overweight or obese, and low physical activity have been associated with the disease. Other factors such as high blood pressure and high cholesterol levels are also risk factors. As a result, the management and control of diabetes largely depends on modification of the modifiable risk factors and use of drugs for insulin production. This enables those with the disease to have a near normal life and function well and to reduce the risk of complications of diabetes such as organ failure.

The Pathophysiology of Diabetes Mellitus

Diabetes mellitus is characterized by complex pathogenesis mechanisms. This is because destruction of beta cells of the pancreas can cause hyperglycemia whereas hyperglycemia alone can also lead to destruction of the pancreatic cells. As such, the pathogenesis is a vicious cycle of events that all lead to destruction of the pancreas and reduced ability of the pancreas to secrete insulin.

Type 1 diabetes mellitus is also known as insulin-dependent diabetes mellitus. Its pathophysiology is attributable to an autoimmune process that leads to T-cell mediated destruction of pancreatic beta cells. This results in inability of the pancreas to secret insulin and ultimately high levels of insulin (Weinstock & Lucier, 2020)Effects of Anti-diabetic drugs in the Management Of Diabetes Mellitus Discussion. The cause of this autoimmune process is unclear. However, genetic and environmental factors can explain the mechanism. There are several autoantibodies associated with immune mediated beta cells destruction including glutamic acid decarboxylase autoantibodies like GAD65 and insulin autoantibodies.

In type 2 diabetes mellitus, also known as non-insulin dependent diabetes mellitus, there is an anomaly in insulin metabolism characterized by insulin resistance and beta cell dysfunction. Insulin resistance leads to a decrease in the sensitivity of cells in tissues to insulin. This coupled with beta cell dysfunction leads to insulin deficiency and eventually hyperglycemia (Garcia et al., 2020). In this form of diabetes, insulin levels are low but are usually enough to prevent severe complications such as DKA. These complications can be precipitated by severe stress conditions such as diseases or by some drugs. Without these physiological stress conditions, these patients typically do not require insulin therapy. Type 2 DM is often associated with obesity/overweight, having a family history of diabetes, lack of physical activity, and advanced age.

Pharmacological agents used in the treatment of diabetes mellitus

Diabetes mellitus type 1- This form of diabetes is known as insulin dependent diabetes mellitus. Therefore, the mainstay therapy includes the use of exogenous insulin throughout their lives. There are various types of insulin available for use including short-acting insulin, rapid-acting insulin, intermediate-acting insulin, and long-acting insulin. The short-acting insulin(regular insulin) has onset of action 30 minutes after injection. Examples include Humulin R and Novolin R. Rapid-acting starts working after about 15 minutes and lasts for about 4 hours. Examples include Glulysine, Lispro and Aspart (Janež et al., 2020). The long-acting insulin can work for as long as 14 to 40 hours and examples include Glargine. Daily injections of a combination of rapid-acting and a long-acting insulin can act like the body’s normal insulin and improve blood sugar levels control.

The main treatment therapy for type 2 diabetes mellitus includes oral antidiabetic agents. The first choice of treatment is Metformin, which works by suppressing gluconeogenesis by the liver and improving glucose uptake by cells. Other agents used are Insulin secretagogues, which include sulfonylureas such as glimepiride and meglitinides such as Nateglinide (Cavaiola & Pettus, 2017)Effects of Anti-diabetic drugs in the Management Of Diabetes Mellitus Discussion. These both have a similar mechanism of action by stimulating insulin sectretion by the beta cells. Some of their side effects include hypoglycemia and weight gain.

Another class of drug used is alpha-glucosidase inhibitors like miglitol. These work by reducing postprandial hyperglycemia through delayed carbohydrate absorption and digestion. Since they have no effect on insulin release, they do not induce hypoglycemia and do not affect body weight significantly (Cavaiola & Pettus, 2017). Thiazolidinediones such as rosiglitazone work to increase insulin sensitivity on muscles and adipose tissues to increase glucose usage and decrease its production.

Other drugs include dipeptidyl peptidase-4 inhibitors such as sitagliptin. These agents inhibit the DPP4 enzyme whose function is to inactivate incretins. Through this, they increase active hormones and improve islet function. DPP4 inhibitors can be used alone in patients with diet-controlled diabetes or together with metformin.

Important information related to advanced practice nurse

In order to achieve good blood sugar control and management of diabetes mellitus, medications should be used with other non-pharmacological modalities such as proper diet control and exercise. Integrating the role of nurse practitioners into the primary care of diabetic patients provides innovative methods to provide support for the patients (Htay & Whitehead, 2021). Advanced nurse practitioners are capable of initiating, changing, or adjusting their patients’ medications to achieve the best results. This improves the clinical outcomes of these patients.

Advanced nurse practitioners can also educate their patients on proper medication use including injection techniques for insulin. They also educate on primary preventive techniques such as engaging in physical activity and weight reduction as well as early screening for early detection in those at risk.

References

Cavaiola, T. S., & Pettus, J. H. (2017). Management Of Type 2 Diabetes: Selecting Amongst Available Pharmacological Agents. NCBI. https://www.ncbi.nlm.nih.gov/books/NBK425702/

Garcia, U. G., Vicente, A. B., Jebari S., Larrea-Sebal, A., Siddiqi H., & Uribe, K. B. (2020). Pathophysiology of Type 2 Diabetes Mellitus. NCBI. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7503727/#:~:text=Type%202%20Diabetes%20Mellitus%20(T2DM,to%20respond%20appropriately%20to%20insulin

Htay M., & Whitehead D. (2021). The effectiveness of the role of advanced nurse practitioners compared to physician-led or usual care: A systematic review. NCBI. https://www.sciencedirect.com/science/article/pii/S2666142X21000163

Janež, A. J., Guja, C., Mitrakou, A., Lalic, N., Tankova, T., & Czupryniak, L. (2020). Insulin Therapy in Adults with Type 1 Diabetes Mellitus: a Narrative Review. NCBI. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6995794/

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National Diabetes statistics report, 2020. (2020, September 28). Centers for Disease Control and Prevention. https://www.cdc.gov/diabetes/data/statistics-report/index.html

Weinstock, R. S., & Lucier J. (2020). Diabetes Mellitus Type 1. NCBI. https://www.ncbi.nlm.nih.gov/books/NBK507713/ Effects of Anti-diabetic drugs in the Management Of Diabetes Mellitus Discussion