Types Of Diabetes Type 2 Medications
- Medical and Pharmacy Editor: Jay W. Marks, MD
Medically Reviewed on 11/23/2020
Oral diabetes medications are used to improve blood sugar control in patients with type 2 diabetes.
Currently, there are nine drug classes of oral diabetes medications approved for the treatment of type 2 diabetes.
These medications differ in the way they function in the body to reduce blood glucose.
Biguanides
Metformin is the only biguanide available in the United States and is generally the first choice for oral treatment of type 2 diabetes mellitus. Metformin improves
- the body’s response to natural insulin,
- decreases the absorption of glucose from the intestines, and
- reduces the production of glucose by the liver.
Sulfonylureas
Sulfonylureas are the oldest classes of oral diabetes medications. Sulfonylureas work primarily by stimulating the release of insulin. Insulin is the hormone responsible for regulating blood glucose by increasing the uptake of blood glucose by tissues and increasing the storage of glucose in the liver.
Meglitinides
Meglitinides and sulfonylureas have a similar mechanism of action. Meglitinides are short-acting glucose-lowering medications. They stimulate the secretion of insulin from the pancreas.
Thiazolidinediones
Thiazolidinediones enhance insulin sensitivity meaning that the effect of a given amount of insulin is greater. Thiazolidinediones also are referred to as peroxisome proliferator-activated receptor ? or PPAR-? agonists.
What Is Type 2 Diabetes
Type 2 diabetes is a chronic disease where the bodys ability to use glucose or sugar as fuel is impaired. Our bodies produce a hormone called insulin which enables sugar from carbohydrates in food we eat to reach the cells and be used as energy. In type 2 diabetes, insulins ability to do its job is compromised, and over time the body actually produces less of it. This means less sugar in the cells for fuel, and more sugar in the blood where it cant be used. Having high levels of blood sugar over time can cause damage to vital organs like the heart, kidneys, nerves, and eyes.
Some risk factors that predispose people to developing type 2 diabetes, such as genetics and age, are not modifiable. Other risk factors, such as being overweight or having obesity, can be altered. This is why losing 5% to 10% of ones baseline weight by healthful eating and physical activity remains the backbone of type 2 diabetes management.
Can I Use Glipizide Or Metformin While Pregnant
Compared to metformin, glipizide may have a higher potential to cause fetal toxicity. According to animal studies, metformin may be safe for use during pregnancy; but no conclusive studies in humans have been conducted. Consult a healthcare provider to determine the best treatment option for you while pregnant.
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What About Taking Oral Diabetes Medications During Pregnancy Or While Breastfeeding
Use of oral diabetes drugs during pregnancy is controversial. For most women, the first step to maintaining optimal blood glucose control during pregnancy is to make appropriate lifestyle and dietary changes. Insulin therapy is the preferred treatment of pregnant women with gestational diabetes or type 2 diabetes who fail to achieve adequate blood glucose control with dietary or lifestyle changes alone.
With the exception of glyburide, all sulfonylureas are classified as FDA pregnancy risk category C .
- Meglitinides, TZDs also are classified as FDA pregnancy risk category C.
- Glyburide, metformin, DPP-4 inhibitors, -glucosidase inhibitors, colesevelam, and bromocriptine are categorized as pregnancy risk category B .
- To prevent fetal harm, use of oral diabetes medications should be avoided during pregnancy if possible.
Oral diabetes drugs can enter the breast milk and can cause hypoglycemia in the newborn. Therefore, careful risk and benefit analysis should be made for each mother and her infant before a decision is made. Use of oral diabetes medications in nursing mothers should be avoided if possible.
Medication For Type 2 Diabetes
People with type 2 diabetes are more likely to develop various medical problems such as damage to their eyes and nerves, as well as heart attacks and strokes. The main goal of taking medication is to prevent this from happening. The most suitable type of medication will depend on things like how severe your diabetes is, your age and whether you already have other health problems.People with type 2 diabetes have high amounts of sugar in their blood, so it may seem logical for them to take medication to lower their blood sugar levels. But that isnt always necessary. Medication is only needed if blood sugar levels cant be regulated any other way, for example by changing your diet or getting more exercise.
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Type 2 Diabetes Treatment: Types Benefits And Side Effects
Canva; Everyday Health
Treatment of;type 2 diabetes is not just limited to the occasional doctors visit: It includes important types of self-care in addition to regular medical care from doctors and other healthcare providers, such as dietitians or mental health professionals.
- Lifestyle measures to manage stress and other issues
- Specialist care to prevent and treat complications
- Bariatric surgery
The cornerstone for all diabetes treatment is a healthy lifestyle that includes diet and exercise, says;Kathleen Dungan, MD, an endocrinologist at the Ohio State University Wexner Medical Center in Columbus. However, diabetes is a progressive disease, which means that even if you are doing well with a particular treatment, it usually fails over time.
The latest updates about care for type 2 diabetes can be found in the American Diabetes Associations;2021 Standards of Medical Care, which lists updates related to diabetes, complications, new technology, and more.
What Are Examples Of Oral Diabetes Medications Available In The Us
-glucosidase inhibitors
Sulfonylureas are grouped into two classes, first and second generation agents.
First generation sulfonylureas include
The only biguanide available in the United States is metformin .
Thiazolidinediones
Bile acid sequestrants
Currently the only bile acid sequestrant approved for the oral treatment of type 2 diabetes is colesevelam .
Dopamine agonists
Bromocriptine mesylate is a dopamine agonist.
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Why Diabetes Is So Bad
- Diabetes is the seventh leading cause of death in the United States and a leading cause of disability.
- In the early stages of diabetes, most people dont experience symptoms. Yet, the damage to organs occurs even in the absence of symptoms. Thats why its critical for people to get their blood sugar checked periodically. Also, symptoms can be mild and intermittent for years,; delaying diagnosis. These include fatigue, blurred vision, frequent urination, numbness or tingling in hands or feet, weight loss and increased thirst and hunger.
Is Glipizide Or Metformin More Effective
Glipizide and metformin are both effective diabetes medications to improve glycemic control in people with Type 2 diabetes. They can be used as monotherapy or as a combination pill called Metaglip. Glipizide and metformin work best when used with a proper diet and exercise regimen.
Metformin remains the first-line therapy for Type 2 diabetes, according to guidelines from the American Diabetes Association . When compared for effectiveness in those with Type 2 diabetes and coronary artery disease, metformin reduces the risk of heart attack and stroke more than glipizide. According to a double-blind, clinical trial, metformin showed a greater cardioprotective effect than glipizide after a period of five years.
Another comparative trial found that metformin provided better blood sugar control than glipizide. Those taking metformin in the study had better fasting plasma glucose levels than glipizide after 24, 36, and 52 weeks. Those taking metformin also had a lower HbA1c level than those taking glipizide after 52 weeks. Metformin caused weight loss and glipizide caused weight gain in treated participants.
Consult a healthcare provider for medical advice on the best treatment for you if you have Type 2 diabetes. Depending on your overall medical condition, blood sugar levels, and other medications you may be taking, one drug may be preferred over the other.
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Type 2 Diabetes Oral Drug Classes
Doctors follow expert practice guidelines when choosing medicines to treat type 2 diabetes. Most people will start with at least one oral medication if lifestyle changes fail to control blood sugar. Classes of type 2 diabetes oral drugs include:
Oral medications are just one part of an overall treatment plan for type 2 diabetes. Eating a balanced diet can help you reach your blood sugar goals. Lifestyle changes, including getting regular physical activity and maintaining a healthy weight, are also important.
Should You Consider Combination Therapy Here’s What You Need To Know
The overriding reason for anyone with type 2 diabetes to add a medication in addition to metformin is to help you better control your blood glucose. This in turn will help reduce your risk of developing common diabetes-related complications.;
If you have type 2 diabetes and are at increased risk for or diagnosed with heart disease, chronic kidney disease, and/or liver failure, its important to become familiar with all of your treatment options, so you are ready to discuss a more effective diabetes management plan with your doctor.
Type 2 Diabetes is a metabolic disorder and an inflammatory state that can put you at higher-than-average risk of developing heart disease, chronic kidney disease and a host of other common complications. The better and more consistently you are able to control your blood glucose levels, the lower your chances that these health problems will occur.
Thats why its still so important to make adjustments to your diet and step-up your physical activity. However, as essential as eating right and getting enough exercise to boost your heart and challenge your muscles, it is equally necessary to follow the best possible medical treatment to assure tight glycemic control and to address any worrisome risk factors.
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S For Weight Loss Success If You Have Type 2 Diabetes
In addition, most people with diabetes should;limit carbohydrates, especially;simple carbohydrates, like white bread, white pasta, white potatoes, white rice, cereal, and juice, Dungan says. They should instead opt for more fresh vegetables and fruit, or high-fiber, whole-grain options, she says, noting that the;Mediterranean diet;is rich in vegetables, lean meats and fish, and monounsaturated fats, and low in saturated fats and simple carbohydrates. She adds that you can monitor your glucose levels one to two hours after meals to determine how the food youve eaten affects your blood sugar.
What Are Oral Diabetes Medications And How Do They Work
Insulin is a hormone produced by cells in the pancreas called beta cells. Insulin helps the body use blood glucose for energy. People with type 2 diabetes do not make enough insulin and/or their bodies do not respond well to it, leading to elevated blood sugar levels. Oraldiabetes medications bring blood sugar levels into the normal range through a variety of ways.
Blood glucose levels rise and fall throughout the day and night. The target blood glucose levels for people with diabetes before meals is 80 to 130 mg/dL, and the target 1 to 2 hours following the start of a meal is less than 180 mg/dL. Medications can help these levels stay within the target ranges.
Blood glucose can become elevated from eating too much, being inactive, not taking enough diabetes medications, sickness, stress, or exercising when blood glucose levels are already high. Blood glucose levels can become too low if you eat less than usual, you miss a snack or meal at the regular time, you’re more active, or you drink alcohol on an empty stomach.
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For A Healthier Heart Avoid These Diabetes Drugs
The following drugs, or drug classes, increase heart disease risk. What to do? Thats simpleavoid them as frontline drugs, says Dr. Mukherjee. The drugs
Sulfonylureas . This class of drugs stimulates the pancreas to make more insulin, but it also causes weight gain and increases the risk for heart attacks. And it makes it harder for the body to recover after a heart attack.
Meglitinides . This class works similarly to sulfonylureas, also causes weight gain and is associated with negative cardiovascular effects, although less severe.
Rosiglitazone . Approved in 1999, Avandia was severely restricted by the FDA in 2010 when it was shown to greatly increase the risk for strokes, heart attacks and heart failure.
Saxagliptin . This drug has been linked with an increase in hospitalization for heart failure.
What Should I Know About Side Effects Of Diabetes Medicines
Side effects are problems that result from a medicine. Some diabetes medicines can cause hypoglycemia, also called low blood glucose, if you dont balance your medicines with food and activity.
Ask your doctor whether your diabetes medicine can cause hypoglycemia or other side effects, such as upset stomach and weight gain. Take your diabetes medicines as your health care professional has instructed you, to help prevent side effects and diabetes problems.
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For People With Cardiovascular Disease
For people with both type 2 diabetes and atherosclerotic cardiovascular disease , 2018 guidelines recommend including the following as part of the antihyperglycemic treatment:
- sodium-glucose cotransporter 2 inhibitors
- or glucagon-like peptide 1 receptor agonists
For those with type 2 diabetes, atherosclerotic CVD and heart failure or a high risk of heart failure, doctors should prescribe:
- sodium-glucose cotransporter 2 inhibitors
For people with type 2 diabetes and chronic kidney disease, the guidelines urge doctors to consider using:
- a sodium-glucose cotransporter 2 inhibitor
- or glucagon-like peptide 1 receptor agonist
There is evidence that these can stop chronic kidney disease, CVD, or both, from getting worse.
Are There Differences Among Types Of Oral Diabetes Medications
Medications That Increase Insulin Production
The earliest oral diabetes drugs were the sulfonylureas. These work by stimulating the pancreas to produce more insulin. The oldest of these drugs still on the market is chlorpropamide , which has been used for more than 50 years. The second-generation sulfonylureas are taken once or twice a day. They include glipizide , glyburide , and glimepiride .
Meglitinides also stimulate the release of more insulin from beta cells. Repaglinide and nateglinide are taken before each of three meals.
Medications That Decrease Glucose Production and Increase Insulin Sensitivity
One drug makes up the class of oral diabetes medications known as the biguanides, and that is metformin . It works by decreasing production of glucose by the liver and by making muscle more sensitive to insulin. The thiazolidinediones, rosiglitazone and pioglitazone , work in a similar way.
Medications That Slow the Breakdown of Carbohydrates
Alpha-glucosidase inhibitors approach the blood glucose issue in a different way. By inhibiting the breakdown of starches in the intestine, these medications slow the rise in blood sugar normally seen after a meal. Examples include acarbose and meglitol .
Medications That Increase Insulin Production and Decrease Glucose Production
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Conditions Treated By Glipizide And Metformin
Glipizide and metformin are both FDA-approved to treat Type 2 diabetes mellitus. Controlling high blood sugar levels can help decrease the risk of complications from diabetes. These complications may include heart disease, kidney disease, liver disease, eye damage, and foot infections.
Metformin is sometimes used off-label to treat other conditions, such as gestational diabetes, or diabetes during pregnancy, and polycystic ovary syndrome . Metformin is also used off-label to treat weight gain thats caused as a side effect of certain antipsychotic medications.
No significant studies have been conducted on the off-label uses of glipizide.
| Condition |
| Off-label |
What Medications Are Used To Treat Type 2 Diabetes
Many people with type 2 diabetes start with the oral drug;Glucophage ;to help control blood sugar levels. You may add other drugs to your regimen, either soon after your diagnosis or months or years later.
There are currently more than 10 classes of;diabetes drugs, each of which;lowers blood sugar;in a different way.
If your current drug regimen isn’t lowering your blood sugar enough, your doctor may elect to add a drug from a different class.
Down the line, you may also need to add;insulin;to your treatment regimen.
Heres a breakdown of the different medications that your healthcare team may prescribe in your diabetes treatment plan.
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Types Of Diabetes Meds
Diabetes medicines work in quite different ways. But all of them lower blood sugar, help improve the bodys use of glucose, and decrease symptoms.
None of these drugs are problem-free; all can fail to control blood sugar adequately over time in some people who are given them. As a result, the different types of drugs are often used in combination. There are a number of combination products that combine two glucose-lowering medications into one pill. And in the last two years the FDA has approved two triple combination pills, Qternmet XR and Trijardy XR, each combining a dipeptidyl peptidase-4 inhibitor, a sodium-glucose co-transporter-2 inhibitor, and metformin. Your doctor may switch you from one type of drug to another and, if diabetes progresses, you may eventually need insulin to control your blood sugar.
Ask Questions Seek Answers For More Personalized Care
First and foremost, you should know what diabetes-related complications you may be facing as these risks will determine which medications are best for you.
In addition, when doctors consider which medications to prescribe to youfrom among the standard and newer types of drugsthey should also consider your personal preferences, such as the timing of the medications in coordination with drugs you are already taking and the formulation of the drug .
They will also consider any drug intolerances, your overall health status, and any risk factors for developing diabetes-related complications.;;
Most importantly, doctors need to be sure that the benefits of taking a particular medication outweigh any harm to the patient from possible risk of side effects, and lastly, they should consider the affordability of any medication they are going to add to your treatment plan.
If the cost is too high or you cannot afford the co-pay, there is no reason to write you a prescription for a drug you wont be taking. Instead, the doctor must be sure that you are willing and able to take the medications as recommended.
Although doctors are advised to consider the practice guidelines of care developed by professional organizations, they must also consider how these treatment recommendations may affect you, and then tailor the general treatment to adjust for your specific needs.5
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