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Today, Dr. Abhishek Shukla discussed the various classes of medications used in the management of diabetes and how each of them works through distinct mechanisms to control blood sugar levels. He explained that the most commonly prescribed first-line drug is Metformin, which belongs to the Biguanide group. Metformin lowers blood glucose by reducing hepatic gluconeogenesis (glucose production from the liver) and decreasing intestinal glucose absorption, while also improving insulin sensitivity — making it easier for the body to utilize glucose effectively.

He further explained that Sulfonylureas, such as Glimepiride and Glipizide, act by binding and blocking ATP-sensitive potassium channels on the pancreatic beta cells. This blockage causes depolarization of the cell membrane, leading to the opening of calcium channels. The influx of calcium triggers the release of stored insulin, thereby helping to lower blood glucose levels. Dr. Shukla also discussed DPP-4 inhibitors (like Sitagliptin and Saxagliptin), which work by blocking the DPP-4 enzyme responsible for breaking down incretin hormones. This action increases incretin levels, which in turn enhances insulin release and reduces glucagon secretion after meals.

He also mentioned newer drug classes such as SGLT2 inhibitors (like Dapagliflozin and Empagliflozin), which help remove excess glucose through urine and have added benefits for heart and kidney health. Another group, Thiazolidinediones (like Pioglitazone), improves insulin sensitivity at the cellular level. For some patients, injectable medications such as Insulin and GLP-1 receptor agonists are required to maintain optimal glucose control. Dr. Shukla emphasized that understanding the mechanism of each drug is vital to managing diabetes effectively and preventing long-term complications.

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