Maganin ciwon sukari

**Magungunan da ake amfani da su a cikin ciwon sukari** suna magance ciwon sukari ta hanyar canza matakin *glucose* a cikin jini.  Banda insulin, yawancin GLP agonists (liraglutide, exenatide, da sauransu), da pramlintide, duk ana gudanar da su ta baki kuma ana kiran su da magungunan hypoglycemic na baka ko wakilai na antihyperglycemic na baka.  Akwai nau'o'in magunguna daban-daban na maganin ciwon sukari, kuma zaɓinsu ya dogara da yanayin ciwon sukari, shekaru, da yanayin mutum, da kuma wasu dalilai.Ciwon sukari nau'in 1 cuta ce ta rashin insulin.  Dole ne a yi amfani da insulin a nau'in 1, wanda dole ne a yi masa allura.
Nau'in ciwon sukari na 2 cuta ce ta jurewar insulin ta sel. Nau'in ciwon sukari na 2 shine mafi yawan nau'in ciwon sukari.  Magani sun haɗa da abubuwan da (1) ƙara adadin insulin da pancreas ke ɓoye, (2) ƙara fahimtar gabobin da ake nufi da insulin, (3) rage yawan adadin glucose daga sashin gastrointestinal, da (4) haɓaka.  asarar glucose ta hanyar fitsari. 
Rukunin magunguna da yawa, galibi ana bayarwa ta baki, suna da tasiri a cikin nau'in ciwon sukari na 2, galibi a haɗe.  Haɗin warkewa a cikin nau'in 2 na iya haɗawa da isoforms na insulin da yawa ko magungunan antihyperglycemic na baka.  Tun daga shekarar ta 2020, FDA ta amince da haɗin gwiwar magungunan antihyperglycemic guda 23 na musamman. Haɗin farko sau uku na masu ciwon sukari na baka an yarda da su a cikin shekarar 2019, wanda ya ƙunshi metformin, saxagliptin, da dapagliflozin.  Wani amincewar haɗin kai sau uku don metformin, linagliptin, da empagliflozin ya biyo baya a cikin shekara ta 2020.
## Insulin
Yawancin lokaci ana ba da insulin ta hanyar subcutaneously, ko dai ta hanyar allura ko ta famfon insulin.  A cikin saitunan kulawa na gaggawa, ana iya ba da insulin ta cikin jini.  Insulin yawanci ana siffanta su da adadin da jiki ke daidaita su, yana haifar da lokuta daban-daban da tsawon lokacin aiki.   Insulin da ke aiki da sauri suna yin girma da sauri kuma daga baya suna narkewa yayin da insulins masu tsayin aiki sukan sami tsawaita lokacin kololuwa kuma suna ci gaba da aiki a cikin jiki na wasu lokuta masu mahimmanci.
Misalan insulins masu saurin aiki (kololuwa a ~ 1 hour) sune:
*Insulin lispro (Humalog)
*Insulin aspart (Novolog)
*Insulin glulisin (Apidra)
Misalan insulins masu gajeriyar aiki (kololuwar sa'o'i 2-4) sune:
Insulin na yau da kullun (Humulin R, Novolin R)
Insulin mai sauri zinc (Semilente)
Misalan insulins masu aiki na tsaka-tsaki (mafi girman awanni 4-10) sune:
Insulin isophane, protamine tsaka tsaki Hagedorn (NPH) (Humulin N, Novolin N)
Insulin zinc (Lente)
Misalan insulins na dogon lokaci (tsawon awanni 24, yawanci ba tare da kololuwa ba) sune:
*Extended insulin zinc insulin (Ultralente)
*Insulin glargine (Lantus)
*Insulin detemir (Levemir)
*Insulin degludec (Tresiba)
Insulin degludec wani lokaci ana rarraba shi daban a matsayin insulin "tsawon tsayi" mai aiki saboda tsawon lokacin aikinsa na kusan sa'o'i 42, idan aka kwatanta da sa'o'i 24 don yawancin shirye-shiryen insulin masu tsayi.
A matsayin nazari na yau da kullun na nazarin da aka kwatanta insulin detemir, insulin glargine, insulin degludec da insulin NPH bai nuna wani fa'ida ba ko mummunan tasiri ga kowane nau'i na insulin don hypoglycemia na dare, hypoglycemia mai tsanani, glycated haemoglobin A1c, infarction na myocardial maras mutuwa.  / shanyewar jiki, ingancin rayuwa mai nasaba da lafiya ko kuma mace-macen duka. Wannan bita ba ta sami bambance-bambance a cikin tasirin amfani da waɗannan analogues na insulin tsakanin manya da yara ba.
Yawancin magungunan maganin ciwon sukari na baki an hana su a cikin ciki, wanda aka fi son insulin.
Ba a sarrafa insulin ta wasu hanyoyi, kodayake an yi nazarin hakan.  An ba da lasisin ɗan gajeren fom ɗin da aka shaƙa amma daga baya aka cire shi.

## ''Sensitizers''
Magungunan insulin suna magance ainihin matsalar a cikin nau'in ciwon sukari na 2 - juriya na insulin.
### Biguanides
Biguanides suna rage yawan fitowar glucose na hanta da kuma ƙara ɗaukar glucose ta gefen gefe, gami da tsokar kwarangwal.  Ko da yake dole ne a yi amfani da shi tare da taka tsantsan a cikin marasa lafiya da ke da rauni na hanta ko aikin koda, metformin, biguanide, ya zama wakilin da aka fi amfani dashi don nau'in ciwon sukari na 2 a cikin yara da matasa.  Daga cikin magungunan ciwon sukari na yau da kullun, metformin shine kawai maganin baka da ake amfani dashi wanda baya haifar da kiba.
Matsakaicin raguwa a cikin ƙimar haemoglobin glycated (A1C) don metformin shine 1.5-2.0%
Metformin (Glucophage) na iya zama mafi kyawun zaɓi ga marasa lafiya waɗanda suma ke da gazawar zuciya, amma ya kamata a dakatar da shi na ɗan lokaci kafin kowane aikin rediyo wanda ya haɗa da bambancin iodinated na ciki, saboda marasa lafiya suna cikin haɗarin lactic acidosis.
An yi amfani da Phenformin (DBI) daga 1960 zuwa 1980s, amma an cire shi saboda haɗarin lactic acidosis.
Hakanan an cire Buformin saboda haɗarin lactic acidosis.
Metformin yawanci shine maganin layin farko da ake amfani dashi don maganin ciwon sukari na 2.  Gabaɗaya, an wajabta shi a farkon ganewar asali tare da motsa jiki da asarar nauyi, sabanin a baya, inda aka wajabta shi bayan cin abinci da motsa jiki sun kasa. Akwai sakin-nan da nan da kuma tsarin tsawaita-saki, yawanci ana keɓe don marasa lafiya da ke fama da lahani na ciki.  Hakanan ana samunsa a hade tare da sauran magungunan ciwon sukari na baka.

### Thiazolidinediones
Thiazolidinediones (TZDs), wanda kuma aka sani da "glitazones," yana ɗaure zuwa PPARγ, proliferator mai kunnawa mai karɓa γ, wani nau'in furotin mai sarrafa makamashin nukiliya wanda ke da hannu cikin rubutun kwayoyin halitta da ke daidaita glucose da mai metabolism.  Waɗannan PPARs suna aiki ne akan abubuwan da ke amsa proliferator proliferator (PPRE). PPREs suna yin tasiri akan kwayoyin halittar insulin, waɗanda ke haɓaka samar da MRNA na enzymes masu dogaro da insulin. Sakamakon ƙarshe shine mafi kyawun amfani da glucose ta sel.  Waɗannan magungunan kuma suna haɓaka ayyukan PPAR-α kuma don haka suna haifar da haɓakar HDL da wasu manyan abubuwan LDL.
Matsakaicin raguwa a cikin ƙimar haemoglobin glycated (A1C) shine 1.5-2.0%.  Wasu misalan su ne:
Rosiglitazone (Avandia): Hukumar Kula da Magunguna ta Turai ta ba da shawarar a cikin Satumba 2010 cewa a dakatar da shi daga kasuwar EU saboda haɓakar haɗarin zuciya da jijiyoyin jini.
Pioglitazone (Actos): ya kasance a kasuwa amma kuma yana da alaƙa da ƙara haɗarin cututtukan zuciya.
Troglitazone (Rezulin): An yi amfani da shi a cikin 1990s, an cire shi saboda hanta da hanta. Yawancin karatu na baya-bayan nan sun haifar da damuwa game da amincin rosiglitazone, kodayake an tabbatar da cewa rukunin, gaba ɗaya, yana da tasiri mai amfani akan ciwon sukari. Babban damuwa shine karuwa a cikin adadin abubuwan da ke faruwa na zuciya mai tsanani a cikin marasa lafiya da ke dauke da shi. Binciken ADOPT ya nuna cewa maganin farko tare da magungunan irin wannan na iya hana ci gaban cututtuka, kamar yadda gwajin DREAM ya yi.  Ofungiyar Asibitin Asiber na Amurka (aace), wanda ke ba da jagororin aikin asibiti don Gudanar da ciwon sukari, na biyu, ko na uku mahimmin aiki Mellitus, a matsayin taƙaitawar zartarwa ta Mellitus, a kan Saflyylurere da α-  masu hana glucosidase.  Duk da haka, ba a fifita su fiye da GLP-1 agonists ko SGLT2 masu hanawa, musamman a cikin marasa lafiya da cututtukan zuciya (wanda liraglutide, empagliflozin, da canagliflozin duk FDA ta amince da su don magance).
Damuwa game da amincin rosiglitazone ya taso ne lokacin da aka buga wani nazari na baya-bayan nan a cikin New England Journal of Medicine. An sami adadi mai yawa na wallafe-wallafe tun daga lokacin, kuma kwamitin Kula da Abinci da Magunguna ya zaɓi, tare da wasu gardama, 20:3 cewa binciken da aka samu ya “goyi bayan siginar cutarwa”, amma ya zaɓi 22:1 don ci gaba da maganin a kasuwa.  Binciken meta-bincike bai sami goyan bayan wani bincike na wucin gadi na gwajin da aka tsara don kimanta batun ba, kuma wasu rahotanni da dama sun kasa kammala takaddamar. Wannan shaida mai rauni don mummunan tasiri ya rage yawan amfani da rosiglitazone, duk da mahimmanci da tasiri mai dorewa akan sarrafa glycemic. Ana ci gaba da karatun aminci.
Sabanin haka, aƙalla babban binciken da ake tsammani, PROactive 05, ya nuna cewa pioglitazone na iya rage yawan abubuwan da ke faruwa na zuciya a cikin mutanen da ke da nau'in ciwon sukari na 2 waɗanda suka riga sun sami bugun zuciya.

### Lyn kinase activators
An ba da rahoton LYN kinase activator tolimidone don ƙarfafa siginar insulin ta hanyar da ta bambanta da glitazones. Filin ya nuna sakamako mai kyau a cikin binciken asibiti na Phase 2a wanda ya ƙunshi batutuwa masu ciwon sukari 130.

## Sakatariya
Secretagogues kwayoyi ne waɗanda ke haɓaka fitarwa daga gland, a cikin yanayin insulin daga pancreas.
### Sulfonylureas
Sulfonylureas su ne na farko da aka yi amfani da su na farko na maganin hyperglycemic na baka.  Su ne asirin insulin, suna haifar da sakin insulin ta hanyar hana tashar KATP na ƙwayoyin beta na pancreatic.  An sayar da nau'ikan waɗannan kwayoyin guda takwas a Arewacin Amurka, amma ba duka sun kasance ba.  Magungunan "ƙarni na biyu" yanzu an fi amfani da su.  Sun fi tasiri fiye da magungunan ƙarni na farko kuma suna da ƙarancin illa.  Duk na iya haifar da kiba.
Jagororin aikin aikin asibiti na yanzu daga ƙimar AACE sulfonylureas (da glinides) a ƙasa da duk sauran nau'ikan magungunan antidiabetic dangane da shawarar da aka ba da shawarar amfani da su azaman na farko, na biyu, ko na uku na wakilai - wannan ya haɗa da bromocriptine, bile acid sequestrant colesevelam, α-glucosidase  masu hanawa, TZDs (glitazones), da masu hana DPP-4 (gliptins).  Ƙananan farashin mafi yawan sulfonylureas, duk da haka, musamman idan aka yi la'akari da mahimmancin tasirin su a cikin raguwar glucose na jini, yana kula da kiyaye su a matsayin mafi kyawun zaɓi a yawancin marasa lafiya - ba masu hana SGLT2 ko GLP-1 agonists ba, azuzuwan da ka'idodin AACE suka fi so.  Bayan metformin, a halin yanzu ana samun su azaman jinsin halitta.
Sulfonylureas yana ɗaure da ƙarfi ga sunadaran plasma.  Sulfonylureas suna da amfani kawai a cikin nau'in ciwon sukari na 2, yayin da suke aiki ta hanyar haɓaka sakin insulin na endogenous.  Suna aiki mafi kyau tare da marasa lafiya sama da shekaru 40 waɗanda ke da ciwon sukari mellitus na ƙasa da shekaru goma.  Ba za a iya amfani da su tare da nau'in ciwon sukari na 1 ba, ko ciwon sukari na ciki.  Ana iya amfani da su lafiya tare da metformin ko glitazones.  Sakamakon farko shine hypoglycemia, wanda ya bayyana ya fi faruwa tare da sulfonylureas fiye da sauran jiyya. Binciken tsarin Cochrane daga 2011 ya nuna cewa jiyya tare da Sulphonylurea bai inganta sarrafa matakan glucose ba fiye da insulin a cikin watanni 3 ko 12 na jiyya.

Wannan bita guda ɗaya ta sami shaidar cewa jiyya tare da Sulphonylurea na iya haifar da dogaro da insulin a baya, tare da kashi 30% na lokuta da ke buƙatar insulin a cikin shekaru 2. Lokacin da bincike ya auna azumin C-peptide, babu wani shiga tsakani da ya yi tasiri a cikin maida hankalinsa, amma insulin ya ci gaba da maida hankali sosai idan aka kwatanta da Sulphonylurea. Duk da haka, yana da mahimmanci a bayyana cewa binciken da ake da shi don haɗawa a cikin wannan bita ya ba da lahani mai yawa a cikin inganci da ƙira. Matsakaicin raguwa a cikin ƙimar haemoglobin glycated (A1C) don sulfonylureas ƙarni na biyu shine 1.0-2.0%.
Wakilan ƙarni na farko
*tolbutamide
*acetohexamide
*tolazamide
*chlorpropamide
*Wakilan ƙarni na biyu
*glipizide
*glibenclamide ko glibenclamide
*glimepiride
*gliclazide
*glycopyramide
*gliquidone

## Sakatariyar da ba sulfonylurea
### Meglitinides
Meglitinides na taimaka wa pancreas don samar da insulin kuma galibi ana kiransa "gajerun sirrin sirri."  Suna aiki akan tashoshi na potassium iri ɗaya kamar sulfonylureas, amma a wani wurin ɗauri na daban. Ta hanyar rufe tashoshin potassium na ƙwayoyin beta na pancreatic, suna buɗe tashoshin calcium, ta yadda za su haɓaka fitar insulin. Ana ɗaukar su tare da ko jim kaɗan kafin abinci don haɓaka amsawar insulin ga kowane abinci.  Idan an tsallake cin abinci, an kuma tsallake maganin.
Matsakaicin raguwa a cikin ƙimar haemoglobin glycated (A1C) shine 0.5-1.0%.
repaglinide
nateglinide
Abubuwan da ba su da kyau sun haɗa da karuwar nauyi da hypoglycemia.
## Masu hana Alpha-glucosidase
Masu hana Alpha-glucosidase su ne "kwayoyin ciwon sukari" amma ba masu aikin hypoglycemic na fasaha ba saboda ba su da tasiri kai tsaye a kan ɓoyewar insulin ko hankali.  Wadannan jami'ai suna jinkirta narkewar sitaci a cikin ƙananan hanji, ta yadda glucose daga sitaci na abinci ya shiga cikin jini a hankali, kuma ana iya daidaita shi da kyau ta hanyar rashin amsawar insulin ko hankali.  Wadannan wakilai suna da tasiri da kansu kawai a farkon matakan rashin haƙuri na glucose, amma suna iya taimakawa tare da wasu wakilai a cikin nau'in ciwon sukari na 2.
Matsakaicin raguwa a cikin ƙimar haemoglobin glycated (A1C) shine 0.5-1.0%.
miglitol
acarbose
voglibose
Ba kasafai ake amfani da waɗannan magungunan a Amurka ba saboda tsananin illar da ke tattare da su (ƙumburi da kumburin ciki).  An fi rubuta su a Turai.  Suna da yuwuwar haifar da asarar nauyi ta hanyar rage adadin sukari da aka daidaita.
## Peptide analogs
### Mimetics incretin da za a iya allurar
Incretins sune asirin insulin.  Manyan kwayoyin dan takara guda biyu wadanda suka cika ka'idojin zama incretin sune glucagon-kamar peptide-1 (GLP-1) da peptide inhibitory na ciki (glucose-dogara insulinotropic peptide, GIP).  Dukansu GLP-1 da GIP suna aiki da sauri ta hanyar enzyme dipeptidyl peptidase-4 (DPP-4).
### Ana iya allurar glucagon-kamar peptide analogs da agonists
Glucagon-kamar peptide (GLP) agonists suna ɗaure ga mai karɓar GLP membrane.[25]  A sakamakon haka, sakin insulin daga ƙwayoyin beta na pancreatic yana ƙaruwa.  Endogenous GLP yana da rabin rayuwa na 'yan mintuna kaɗan kawai, don haka analogue na GLP ba zai yi aiki ba.  Tun daga shekarar 2019, AACE ya lissafa GLP-1 agonists, tare da masu hana SGLT2, a matsayin mafi fifikon maganin ciwon sukari bayan metformin.  Liraglutide musamman ana iya la'akari da layin farko a cikin marasa lafiya masu ciwon sukari tare da cututtukan zuciya, kamar yadda ya sami izinin FDA don rage haɗarin manyan cututtukan zuciya mara kyau a cikin marasa lafiya da nau'in ciwon sukari na 2.[15] [26]  A cikin bita na 2011 Cochrane, GLP-1 agonists sun nuna kusan raguwar 1% a cikin HbA1c idan aka kwatanta da placebo.[22]  GLP-1 agonists suma suna nuna haɓaka aikin beta-cell, amma wannan tasirin baya ɗorewa bayan an daina magani.[22]  Saboda ɗan gajeren lokacin nazarin, wannan bita bai ba da damar yin la'akari da sakamako mai kyau na dogon lokaci ko mummunan tasiri ba.[22]
Exenatide (kuma Exendin-4, wanda aka sayar dashi azaman Byetta) shine farkon GLP-1 agonist wanda aka amince dashi don kula da nau'in ciwon sukari na 2.  Exenatide ba analogue ne na GLP amma a maimakon GLP agonist. Exenatide yana da kawai 53% homology tare da GLP, wanda ke ƙara juriya ga lalacewa ta hanyar DPP-4 kuma ya tsawaita rabin rayuwarsa. Binciken Cochrane na 2011 ya nuna raguwar HbA1c na 0.20% fiye da Exenatide 2 mg idan aka kwatanta da glargine insulin, exenatide 10 μg sau daya a rana, sitagliptin da pioglitazone. Exenatide, tare da liraglutide, ya haifar da asarar nauyi fiye da glucagon-kamar peptide analogues.[22]
Liraglutide, analog ɗin ɗan adam na yau da kullun (97% homology), Novo Nordisk ne ya haɓaka shi a ƙarƙashin alamar alama Victoza.  Hukumar Kula da Magunguna ta Turai (EMEA) ta amince da samfurin a ranar 3 ga Yuli, 2009, da Hukumar Abinci da Magunguna ta Amurka (FDA) a ranar 25 ga Janairu, 2010. Binciken Cochrane na 2011 ya nuna raguwar HbA1c na 0.24% fiye da liraglutide 1.8 MG idan aka kwatanta da glargine insulin, 0.33% fiye da exenatide 10 µg sau biyu kowace rana, sitagliptin da rosiglitazone.[22]  Liraglutide, tare da exenatide, ya haifar da asarar nauyi fiye da glucagon-kamar peptide analogues.
Taspoglutide a halin yanzu yana cikin gwajin asibiti na Phase III tare da Hoffman-La Roche.
Lixisenatide (Lyxumia) Sanofi Aventis
Semaglutide (Ozempic) (Sigar baka shine Rybelsus)
Dulaglutide (Trulicity) - sau ɗaya a mako
Albiglutide (Tanzeum) - sau ɗaya a mako
Hakanan waɗannan magunguna na iya haifar da raguwar motsin ciki, da alhakin illar tashin hankali na gama gari, wanda yakan ragu da lokaci.
### Analogs peptide inhibitory na ciki
Dipeptidyl peptidase-4 inhibitors ===
Analogs na GLP-1 sun haifar da asarar nauyi kuma suna da ƙarin sakamako masu illa na gastrointestinal, yayin da gabaɗaya masu hanawa dipeptidyl peptidase-4 (DPP-4) sun kasance masu tsaka tsaki kuma suna haɓaka haɗarin kamuwa da cuta da ciwon kai, amma duka azuzuwan sun bayyana don gabatar da madadin ga  sauran magungunan ciwon sukari.  Duk da haka, an lura da karuwar nauyi da / ko hypoglycemia lokacin da aka yi amfani da masu hana dipeptidyl peptidase-4 tare da sulfonylureas;  Har yanzu ba a san illolin kiwon lafiya na dogon lokaci da yawan cututtuka ba.
Masu hanawa DPP-4 suna haɓaka haɓakar jini na incretin GLP-1 ta hanyar hana lalata ta DPP-4.
Misalai su ne:
vildagliptin (Galvus) EU Amincewa da 2008
sitagliptin (Januvia) FDA ta amince da Oktoba 2006
Saxagliptin (Onglyza) FDA An Amince da Yuli 2009
linagliptin (Tradjenta) FDA An Amince da Mayu 2, 2011
*alogliptin
*Septagliptin
*teneligliptin
*Gemigliptin (Zemiglo)
Masu hana DPP-4 sun saukar da ƙimar haemoglobin A1C da 0.74%, kwatankwacin sauran magungunan antidiabetic.[37]
Sakamakon RCT guda ɗaya wanda ya ƙunshi marasa lafiya 206 masu shekaru 65 ko fiye (ma'anar asali HgbA1c na 7.8%) suna karɓar ko dai 50 ko 100 mg/d na sitagliptin an nuna don rage HbA1c da 0.7% (haɗin sakamako na duka allurai).[38]  Sakamakon haɗe-haɗe na 5 RCTs yana ba da jimillar marasa lafiya 279 masu shekaru 65 ko sama da haka (ma'anar asali na HbA1c na 8%) waɗanda ke karɓar 5 mg/d na saxagliptin an nuna don rage HbA1c da 0.73%.[39]  Sakamakon haɗe-haɗe na 5 RCTs wanda ke yin rajistar jimlar marasa lafiya 238 masu shekaru 65 ko fiye (ma'anar asali na HbA1c na 8.6%) suna karɓar 100 mg / d na vildagliptin an nuna don rage HbA1c da 1.2% [40]  Wani saitin 6 da aka haɗu da RCTs wanda ya haɗa da alogliptin (wanda FDA ta amince da shi a cikin 2013) an nuna shi don rage HbA1c da 0.73% a cikin marasa lafiya 455 masu shekaru 65 ko fiye waɗanda suka karbi 12.5 ko 25 mg / d na maganin.[41]
### analogues amylin da za'a iya allura
Wannan sashe bai kawo wani tushe ba.  Da fatan za a taimaka inganta wannan sashe ta hanyar ƙara ambato zuwa amintattun tushe.  Ana iya ƙalubalanci abubuwan da ba a samo su ba kuma a cire su.  (Janairu 2016) (Koyi yadda da lokacin cire wannan saƙon samfuri)
Amylin agonist analogues yana jinkirin zubar da ciki kuma yana kashe glucagon.  Suna da duk ayyukan incretins ban da haɓakar ƙwayar insulin.  Tun daga 2007, pramlintide shine kawai analog na amylin a asibiti.  Kamar insulin, ana gudanar da shi ta hanyar allurar subcutaneous.  Mafi yawan lokuta da mummunan tasirin pramlintide shine tashin zuciya, wanda ke faruwa mafi yawa a farkon jiyya kuma a hankali yana raguwa.  Matsakaicin raguwa a cikin ƙimar A1C shine 0.5-1.0%.
## Glycosuric
Masu hana SGLT-2 suna toshe sake ɗaukar glucose a cikin tubules na koda, suna haɓaka asarar glucose a cikin fitsari.  Wannan yana haifar da asarar nauyi mai sauƙi, da kuma raguwa mai sauƙi a cikin matakan sukari na jini tare da ƙarancin haɗarin hypoglycemia.[42]  Ana iya samun shirye-shiryen baka kadai ko a hade tare da wasu wakilai[43].  Tare da GLP-1 agonists, ana ɗaukar su an fi so su zama wakilai na biyu ko na uku don nau'in ciwon sukari na 2 wanda aka fi dacewa da shi tare da metformin kaɗai, bisa ga ƙa'idodin aikin asibiti na kwanan nan.[15]  Saboda ana ɗaukar su da baki, maimakon allura (kamar GLP-1 agonists), marasa lafiya waɗanda ke da kyamar allura na iya fifita waɗannan wakilai fiye da na farko.  Ana iya la'akari da su a layi na farko a cikin masu ciwon sukari masu fama da cututtukan zuciya, musamman ma ciwon zuciya, kamar yadda aka nuna waɗannan magungunan suna rage haɗarin asibiti ga marasa lafiya masu irin wannan cututtuka. Saboda ba a samun su azaman magunguna na yau da kullun, duk da haka, farashi na iya iyakance yuwuwar su ga marasa lafiya da yawa.  Bugu da ƙari kuma, an sami ƙarar shaidar cewa inganci da amincin wannan rukunin magunguna na iya dogara da bambancin kwayoyin halitta na marasa lafiya.
Misalai sun haɗa da:
*Dapagliflozin
*Canagliflozin
*Empagliflozin
*Remogliflozin
Sakamakon sakamako na masu hana SGLT-2 suna samuwa kai tsaye daga tsarin aikin su;  waɗannan sun haɗa da ƙara haɗarin: ketoacidosis, cututtuka na urinary fili, candidal vulvovaginitis, da hypoglycemia.
## Gabaɗaya
Yawancin magungunan rigakafin ciwon sukari suna samuwa a matsayin nau'i.  Wadannan sun hada da:[49]
Sulfonylureas - glimepiride, glipizide, gliburide
Biguanides - metformin
Thiazolidinediones (Tzd) - pioglitazone, Actos generic
Alpha-glucosidase inhibitors - Acarbose
Meglitinides - nateglinide Haɗuwa da sulfonylureas da metformin - wanda aka sani da jerin sunayen magungunan biyu
Babu wani nau'i na nau'i na dipeptidyl peptidase-4 inhibitors (Januvia, Onglyza), glifozins, incretins da haɗuwa daban-daban.
## Madadin Magani
An yi bincike game da tasirin jiyya na Ayurvedic, duk da haka saboda kurakuran binciken da aka yi amfani da su, ba a iya yanke hukunci game da ingancin waɗannan jiyya ba kuma babu isassun shaidun da za su ba da shawarar su.[50]
## Manazarta