The chart below describes the medications most commonly used to treat type 2 diabetes.
Medications for Type 2 Diabetes
| Medications | What Are They? | How Do They Work? | How Are They Given? | What Else Should I Know? |
Meglitinides
|
Non-sulfonylurea secretagogues (insulin-secretion stimulators) | Activate insulin release
|
TabletAlso available combined with another antidiabetic medication | To be sure the medication works properly, follow the meal plan your doctor gave you exactly. |
SulfonylureasExamples:
|
Bind to pancreatic cell membranes, leading to increased insulin release | Activate insulin releaseMay also: Limit sugar production and slow insulin clearance in the liver | TabletAlso available combined with other antidiabetic medications | Sulfonylureas raise insulin levels regardless of whether you’ve eaten—and especially if you drink alcoholic beverages.Stay alert for symptoms of low blood sugar, such as confusion, blurred vision |
Dipeptidyl peptidase-4 (DPP-4) inhibitors
|
Block release of enzyme dipeptidyl peptidase-4, leading to rise in gut peptide GLP-1 (C) | Activate insulin releaseReduce sugar (glucose) release from the liverSlow gastric emptying | TabletAlso available combined with other antidiabetic medications | Saxagliptin: To be sure it works properly, take it exactly as prescribed. |
Biguanide
|
Developed from the identification of guanidine and related glucose-lowering compounds found in the French lilac plant, Galega officinalis | Reduces sugar (glucose) release from the liverImproves insulin sensitivity (the body’s ability to use insulin)May promote modest weight loss and modest decline in low-density lipoprotein (LDL), or “bad” cholesterol | TabletAlso available combined with other antidiabetic medications | Metformin stands alone in its class. It works completely differently from all other antidiabetic medications. |
Thiazolidinediones(Also called glitazones)
|
Compounds (thiazoles) containing nitrogen and sulfur | Reduce sugar (glucose) release from the liver.Improve insulin sensitivity (the body’s ability to use insulin)May slightly increase high-density lipoprotein (HDL), or “good” cholesterol | TabletAlso available combined with other antidiabetic medications
|
Current research into the protein PPAR-gamma (which is acted on by thiazolidine-diones) may one day help uncover the cause of diabetes.PPAR-gamma is known to play a key role in diabetes development as well as treatment. |
Alpha-glucosidase inhibitors
|
Saccharides (carbohydrates) that block enzymes needed to digest carbohydrates | Slow the breakdown of starches and some sugars, reducing the speed of digestionDo not cause weight gain | Tablet | To work properly, these medications must be taken at the start of each main meal. |
Bile Acid Sequestrant
|
A bile-acid–binding medication (bile breaks up fats during digestion)Also lowers blood sugar | Reduces low-density lipoprotein (LDL, “bad”) cholesterolNot known how it works on blood sugar levels | TabletLiquid | Follow your doctor’s instructions for taking this medication exactly. DO NOT take more of it, or take it more often, or take it for a longer time. |
| InsulinMay be used to treat type 2 diabetes when diet, exercise, and oral medications do not work | A hormone produced in the pancreas that regulates blood sugar levels | Causes cells to absorb blood sugar, taking it out of the bloodReduces blood sugar production in the liver | Injection by needle/ syringe or insulin pen
|
Insulins vary:Short-acting insulin is used after a meal (in addition to the following longer-acting insulins).Intermediate-acting and long-acting insulin are used to maintain the body’s basic insulin needs over half a day or a whole day, respectively. |
Glucagon-like Peptide-1 (GLP-1) Receptor Agonists
|
Pramlintide:A man-made form of a naturally occurring hormoneExenatide:A man-made form of a naturally occurring hormoneLiraglutide:
A man-made form of a naturally occurring hormone
|
Pramlintide: Activates insulin release. Slows passage of food through the body, slowing rise in blood sugar level. Reduces sugar (glucose) production in the liver.Increases feeling of fullness after eating, helping to reduce appetite and food intakeExenatide: Activates insulin releaseSlows stomach emptyingReduces sugar (glucose) production in the liverMay cause weight lossLiraglutide: Activates insulin releaseWhen blood sugar levels are high, helps pancreas release required insulin amountHelps move sugar from blood to other body tissues
Slows stomach emptying, may reduce appetite and weight |
Pramlintide:
Administered together with insulin (not in the same syringe) Exenatide:
Other medications may also be given Liraglutide:
Prefilled dosing pen for injection under the skin |
Pramlintide: If you skip a meal, DO NOT take the related pramlintide dose. Take your next dose with your next meal.Exenatide: DO NOT take a dose after eating.Liraglutide: If you miss a dose: Inject it as soon as you realize you missed it, except: If it’s close to your next dose, skip the missed one and wait until the next dose. DO NOT inject a double dose. |
Clinical Efficacy of Oral Hypoglycemic Agents
| Class of hypoglycemic agents | Reduction in HbA1c(%) | Reduction in FPG (mg per dL [mmol per L]) |
|---|---|---|
|
Sulfonylureas |
0.8 to 2.0 |
60 to 70 [3.3 to 3.9] |
|
Meglitinides |
0.5 to 2.0 |
65 to 75 [3.6 to 4.2] |
|
Biguanides |
1.5 to 2.0 |
50 to 70 [2.8 to 3.9] |
|
Thiazolidinediones |
0.5 to 1.5 |
25 to 50 [1.4 to 2.8] |
|
Alpha-glucosidase inhibitors |
0.7 to 1.0 |
35 to 40 [1.9 to 2.2] |
HbA1c = glycosylated hemoglobin A1c; FPG = fasting plasma glucose.
