Antidiabetic drug of choice for obese patients

Ans. (a) MetforminRef KDT 6th ed. 1267# metformin* Metformin is an antidiabetic drug from biguanides category.* They improve lipid profile, hence considered as DOC for DM in obese patients.* MOA:# increase peripheral utilization of glucose# Inhibit hepatic gluconeogenesis* Metformin never causes hypoglycemia.* Another drug from Biguanides is Phenformin, which is withdrawn, because it causes lactic acidosis.* Sulfonylureas causes a brisk release of insulin from pancreas which stimulate the functional receptors for the intake of glucose.# they can cause hypoglycemia.# Preferred in thin patients with DM* Repaglinide has same MOA as sulfonylureas, but it is short acting.# Used to control sudden rise of glucose after meal.* Acarbose act by inhibiting G.I. absorption of sugar.# s/e: can cause osmotic diarrhea.Also Know* Safest sulfonylureas: Tolbutamide (safer in elderly also)* Remembered as: MOST- Metformin for Obese; Sulfonylureas for Thin.