Special Considerations for Management of Diabetes in Adult Patients with Intellectual and Developmental Disabilities

Table 4

Pharmacological treatment for individuals with metabolic syndrome.

Drug class	Mechanism of action	Indication	Side effects	Contraindications	Weight impact
Biguanides (metformin)	(i) Increases peripheral insulin sensitivity and enhances insulin effects; (ii) Reduces LDL and increases HDL	Drug of choice in almost all patients with T2DM	(i) Lactic acidosis; (ii) GI distress: nausea, vomiting, diarrhea, and abdominal pain; (iii) Vitamin B12 deficiency	(i) Renal failure; (ii) Severe liver failure; (iii) Chronic pancreatitis; (iv) Shock; (v) Sepsis	Promotes weight loss
SGLT-2 inhibitors (dapagliflozin, and empagliflozin)	(i) Decrease in glucose reabsorption by inhibiting SGLT-2 receptor in the kidney	Treatment-compliant patients with T2DM	(i) Urinary tract infections; (ii) Dehydration; (iii) Diabetic ketoacidosis	(i) Renal failure; (ii) Patients with renal tract abnormalities	Promotes weight loss
GLP-1 receptor agonist (exenatide, liraglutide, and dulaglutide)	(i) Increased insulin secretion; (ii) Decreased glucagon secretion; (iii) Delayed gastric emptying	Treatment-compliant patients with T2DM	(i) GI distress: nausea and vomiting; (ii) Increased risk of pancreatitis	(i) Pre-existing gastrointestinal motility disorders; (ii) Chronic pancreatitis; (iii) Medullary thyroid cancer or MEN2	Promotes weight loss
DPP-4 inhibitors (sitagliptin, saxagliptin, and linagliptin)	(i) Inhibits degradation of DPP4; (ii) Increased insulin secretion; (iii) Decreased glucagon secretion; (iv) Delayed gastric emptying	Treatment-compliant patients with T2DM	(i) GI distress: diarrhea and constipation; (ii) Increased risk of pancreatitis; (iii) Worsening renal function; (iv) Headaches, dizziness	(i) Liver failure; (ii) Renal failure	No significant weight changes
Thiazolidinediones (pioglitazone and rosiglitazone)	(i) Activation of the transcription factor PPARγ; (ii) Increased glucose utilization; (iii) Increased fat storage; (iv) Decreased hepatic glucose production	T2DM patients with renal failure and/or contraindications to insulin therapy	(i) Increased risk of heart failure; (ii) Osteoporosis; (iii) Fluid retention	(i) Congestive heart failure; (ii) Liver failure	Promotes weight gain
Sulfonylureas (glimepiride, glyburide, and glipizide)	(i) Inhibits ATP-sensitive potassium channels in the pancreas leading to increased insulin secretion; (ii) Increased insulin sensitivity; (iii) Decreased gluconeogenesis	T2DM patients who have normal BMI and do not consume alcohol	(i) Life-threatening hypoglycemia; (ii) Renal failure; (iii) Alcohol intolerance; (iv) Hemolytic anemia	(i) Beta-blockers; (ii) Obesity; (iii) Severe liver or renal failure; (iv) Sulfonamide allergy; (v) Cardiovascular comorbidities	Promotes weight gain
Alpha-glucosidase inhibitors (acarbose and miglitol)	(i) Inhibit alpha glucosidase; (ii) Delayed glucose absorption; (iii) Decreased carbohydrate breakdown and no risk of hypoglycemia	Treatment-compliant patients with T2DM	(i) GI distress: flatulence, bloating, abdominal pain, and diarrhea	(i) Renal failure; (ii) Inflammatory bowel disease	No significant weight changes
Statin (atorvastatin, rosuvastatin, and simvastatin)	(i) Inhibits HMG-CoA reductase enzyme reducing cholesterol synthesis; (ii) Upregulates LDL receptors	Treatment of hypercholesterolemia, hyperlipoproteinemia, and hypertriglyceridemia	(i) Myopathy; (ii) Rhabdomyolysis; (iii) Hepatotoxicity; (iv) Increased risk of developing T2DM	(i) Active hepatic disease; (ii) Breastfeeding; (iii) Other CYP450 inhibitors	Promotes weight gain
Cholesterol absorption inhibitors (ezetimibe)	(i) Inhibit the intestinal absorption of dietary and biliary cholesterol; (ii) Lowers LDL-C, modestly decreases triglycerides, and raises HDL-C	Primary hypercholesterolemia	(i) Myopathy; (ii) Hepatotoxicity	(i) Hypersensitivity to any component of formulation; (ii) Unexplained persistent elevation in serum transaminases	No significant weight changes

SGLT2, sodium-glucose cotransporter 2; GLP-1, glucagon-like peptide 1; DPP-4, dipeptidyl-peptidase 4; LDL, low-density lipoprotein; HDL, high-density lipoprotein; PPARγ, peroxisome proliferator-activated receptor gamma; HMG-CoA, β-Hydroxy β-methylglutaryl-CoA [75–77].