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Diabetes treatment: Medications for type 2 diabetes
By Mayo Clinic staffHealthy lifestyle choices — including diet, exercise and weight control — are an important part of diabetes treatment. If you have type 2 diabetes, sometimes medication to control blood sugar is needed, too. Sometimes a single medication is effective. In other cases, a combination of medications works better.
The list of medications for type 2 diabetes is long and potentially confusing. So how do you know which diabetes treatment is best for you? Here's help in comparing your options.
Diabetes treatment: Many choices
Medications for type 2 diabetes come in various classes — alpha-glucosidase inhibitors, amylin agonists, dipeptidyl-peptidase 4 (DPP-4) inhibitors, meglitinides, sulfonylureas and thiazolidinediones. Each class contains one or more specific drugs. Some of these drugs are taken orally. Others must be injected.
Various diabetes drugs work in different ways to lower blood sugar. A drug may work by:
- Stimulating the pancreas to produce and release more insulin
- Inhibiting the production and release of glucose from the liver, which means you need less insulin to transport sugar into your cells
- Blocking the action of stomach enzymes that break down carbohydrates or make tissues more sensitive to insulin.
Compare diabetes medications
Here's an at-a-glance comparison of common diabetes medications. More medications are available depending on your needs and situation. Ask your doctor about your options and the pros and cons of each.
| Medications (examples) | How they're taken | Advantages | Disadvantages |
|---|---|---|---|
| Medications that increase insulin production | |||
Dipeptidyl-peptidase 4 (DPP-4) inhibitors
|
By mouth | Don't cause weight gain | May cause upper respiratory tract infection, sore throat and headache; sitagliptin has been associated with severe inflammation of the pancreas |
Glucagon-like peptide 1 (GLP-1) agonists
|
By injection | May promote weight loss | May cause nausea, headache and dizziness; rarely, may cause kidney problems including kidney failure; taken twice a day |
Meglitinides
|
By mouth | Work quickly | May cause low blood sugar and weight gain; taken three times a day |
Sulfonylureas
|
By mouth | Can be used alone or with other diabetes medications; work quickly | May cause low blood sugar, nausea and weight gain |
| Medications that improve the effectiveness of insulin | |||
| Metformin (Fortamet, Glucophage, others) | By mouth | Don't cause weight gain; may decrease LDL ("bad") cholesterol and triglycerides | May cause nausea and diarrhea; rarely, may cause a harmful buildup of lactic acid (lactic acidosis) |
Thiazolidinediones
|
By mouth | May slightly increase HDL ("good") cholesterol | May cause swelling and weight gain that leads to or worsens heart failure; may increase LDL ("bad") cholesterol; may increase risk of heart attack; rarely, may cause liver problems |
| Medications that affect food absorption | |||
Alpha-glucosidase inhibitors
|
By mouth | Don't cause weight gain | May cause nausea and diarrhea; taken three times a day |
How to choose your diabetes medication
No single diabetes treatment is best for everyone, and what works for one person may not work for another. This is where your health care provider comes in. He or she can help you compare the advantages and disadvantages of specific diabetes drugs, as well as determine how a specific medication or multiple medications may fit into your overall diabetes treatment plan. Sometimes insulin therapy becomes necessary.
Also remember that there's more to diabetes treatment than medication. Eating healthy foods, including physical activity in your daily routine and maintaining a healthy weight can help you control your diabetes. In fact, lifestyle changes may reduce — or eliminate — the need for diabetes medication.
- Bolen S, et al. Systematic review: Comparative effectiveness and safety of oral medications for type 2 diabetes mellitus. Annals of Internal Medicine. 2007;147:386.
- Other diabetes medications. American Diabetes Association. http://www.diabetes.org/type-2-diabetes/oral-medications.jsp. Accessed Aug. 25, 2009.
- What I need to know about diabetes medications. National Institute of Diabetes and Digestive and Kidney Diseases. http://diabetes.niddk.nih.gov/dm/pubs/medicines_ez/meds.pdf. Accessed Aug. 25, 2009.
- McCulloch DK. Sulfonylureas and meglitinides in the treatment of diabetes mellitus. http://www.uptodate.com/home/index.html. Accessed Aug. 26, 2009.
- Nathan DM, et al. Medical management of hyperglycemia in type 2 diabetes: A consensus algorithm for the initiation and adjustment of therapy. Diabetes Care. 2009;32:193.
- Sitagliptin (marketed as Januvia and Janumet) — acute pancreatitis. U.S. Food and Drug Administration. http://www.fda.gov/Safety/MedWatch/SafetyInformation/SafetyAlertsforHumanMedicalProducts/ucm183800.htm. Accessed Sept. 28, 2009.
- FDA: Byetta label revised to include safety information on possible kidney problems. U.S. Food and Drug Administration. http://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm188708.htm. Accessed Nov. 3, 2009.
