Medications for Diabetes

Controlling blood sugar levels helps manage type 2 diabetes (T2D). Having high blood sugar (glucose) can lead to health problems. The main part of therapy is lifestyle management. This involves a healthy diet and regular exercise.^1-3

Many people with T2D also need prescription drugs to control blood sugar levels. Many types of drugs are used to treat T2D. Talk to your doctor about the risks and benefits of each type. You may need to try different medicines to find the best ones for you.^1,4

How do medicines work to treat type 2 diabetes?

In T2D, your blood glucose (sugar) levels become too high. This can happen if your pancreas does not make enough insulin. Insulin helps move glucose out of your bloodstream and into your cells. T2D can also occur if your body does not use insulin properly.¹

T2D drugs work in different ways to reduce your blood sugar. Common ways that they work include:^2,4

• Improving how your body uses insulin
• Increasing insulin production by the pancreas
• Reducing glucose production by the liver
• Increasing glucose excretion in urine
• Reducing the effect of carbohydrates on blood sugar
• Slowing food moving through the stomach

Choosing between T2D medicine options

Most people start treatment with metformin after being diagnosed with T2D. Certain people may not be able to take metformin. If glucose levels are high after 2 to 3 months with metformin, your doctor may recommend another drug. The right add-on medicine depends on personal factors, including your:^1,3,5,6

• Weight
• Risk of low blood sugar
• Health history
• Side effects
• Cost
• Personal preference

Biguanides

Metformin is the only biguanide available. It reduces the amount of glucose produced by the liver. It also improves how well your body uses insulin. Metformin is the most common medication for T2D. It may be given alone or with other drugs.^1,2

Alpha-glucosidase inhibitors (AGIs)

AGIs slow down how carbohydrates are absorbed by your intestines. When you eat carbohydrates, your blood sugar increases. AGIs reduce how much your blood sugar increases after eating. Two AGIs are approved to treat T2D:¹

• Acarbose (Precose®)
• Miglitol (Glyset®)

Thiazolidinediones (TZDs)

TZDs improve how your body uses insulin. This reduces how much insulin is needed to remove glucose from the blood. Two TZDs are approved to treat adults with T2D:¹

• Rosiglitazone maleate (Avandia®)
• Pioglitazone (Actos®)

Sulfonylureas

Sulfonylureas trigger beta cells in the pancreas. This causes the pancreas to release more insulin. Examples of sulfonylureas include:¹

• Glimepiride (Amaryl®)
• Glipizide/Glipizide XL (Glucotrol®, Glucotrol® XL)
• Glibenclamide (Glynase® PresTab, Glynase®, Micronase®)

Meglitinides

Meglitinides work similarly to sulfonylureas. However, they work faster than sulfonylureas. They may be helpful for people with allergies to sulfonylureas. Two meglitinide derivatives are approved to treat T2D:¹

• Repaglinide (Prandin®)
• Nateglinide (Starlix®)

Glucagon-like peptide-1 (GLP-1) receptor agonists and dual agonists

GLP-1 agonists mimic incretin hormones. These hormones trigger the pancreas to release more insulin after eating. GLP-1 agonists increase insulin production by the pancreas. Examples of GLP-1 receptor agonists include:^1,6,7

• Exenatide (Byetta®)
• Exenatide ER (Bydureon®)
• Lixisenatide (Adlyxin®)
• Liraglutide (Victoza®)
• Dulaglutide (Trulicity®)
• Semaglutide (Ozempic®, Rybelsus®)

Gastric inhibitory peptide (GIP) is another type of incretin hormone. Some drugs mimic both GIP and GLIP-1. These are called dual GIP-GLP agonists. Examples include Trizepatide (Mounjaro®).⁸

Dipeptidyl peptidase 4 (DPP-4) inhibitors

DPP-4 inhibitors block enzymes that break down incretin. This increases incretin levels. Examples include:¹

• Alogliptin (Nesina®)
• Sitagliptin (Januvia®)
• Saxagliptin (Onglyza®)
• Linagliptin (Tradjenta®)

Selective sodium-glucose co-transporter 2 (SGLT2) inhibitors

SGLT2 inhibitors reduce how kidneys reabsorb glucose into the body. This increases how much glucose is excreted in urine. These drugs may improve heart and kidney health. Examples of include:^1,2,7

• Bexagliflozin (Brenzavvy™)
• Dapaglifliozin (Farxiga®)
• Canagliflozin (Invokana®)
• Empagliflozin (Jardiance®)
• Ertuglifliozin (Steglatro®)

Amylin analogs

Amylin analogs mimic “amylin” hormones. These hormones work with insulin to reduce blood sugar. Amylin analogs also slow down how food moves through the stomach. One amylin analog used in T2D is called Pramlintide (Smylin®).⁴

Bile acid sequestrants (BASs)

BASs are typically used to lower cholesterol. But they may lower blood sugar by reducing glucose production by the liver. Colesevelam (WelChol®) is the only approved BAS for treating people with T2D.^4,5,8

Dopamine agonists

Dopamine agonists are typically used to treat other health conditions. But they may lower blood sugar by improving how your body uses insulin. The only dopamine agonist approved to treat T2D is Bromocriptine (Cycloset®).⁸

Insulin

Some people with T2D must take insulin to control blood sugar. There are many different types of insulin products available. They start working, reach their peak, and last for different amounts of time. These types are:^1,9

• Rapid-acting insulin – starts working within 15 minutes, peaks after 1 hour, and lasts for 2-4 hours
• Short-acting (regular) insulin – starts working after 30 minutes, peaks between 2-3 hours, and lasts for 3-6 hours
• Intermediate-acting insulin – starts working within 2 hours, peaks after 4-12 hours, and lasts for 12-18 hours
• Long-acting insulin – starts working within several hours, peaks after 3-14 hours, and lasts for 24 hours
• Ultra-long-acting insulin – can last 36 hours or longer
• Premixed insulin – products combine two different types of insulin in a single injected dose (usually a rapid-acting and an intermediate-acting)

Combination treatments

Combination treatments have 2 drugs in a single tablet. A single table is easier to take than taking multiple tablets. Many options combine metformin with another drug. Non-metformin combinations are also available.^5,8

Before beginning treatment for type 2 diabetes, tell your doctor about all your health conditions and any other drugs, vitamins, or supplements you are taking. This includes over-the-counter drugs.