Type 2 Diabetes Oral Medications
Some people with type 2 diabetes need medications to help control blood glucose levels. Medications are prescribed by a physician should be used in conjunction with eating well and exercising as a way to better manage type 2 diabetes.
There are several classifications of diabetes medications. Your healthcare team will guide you on how to figure out which diabetes medication is best for you.
Oral Diabetes Medications
The following classes of oral medications work in different ways to help treat diabetes by lowering blood glucose levels:1,2,3*
• Alpha-glucosidase inhibitors
• Bile acid sequestrants
• DPP-4 inhibitors
• SGLT2 inhibitors
The goal for medication therapy of type 2 diabetes is generally an HbA1c of less than 7%.1 However, your health care provider will determine your HbA1c goal based on individual factors. Used alone, oral drugs generally lower HbA1c by less than 2%.1 Your healthcare provider may consider a combination therapy, usually comprised of metformin and one of these six treatment options: a sulfonylurea, thiazolidinedione, DPP-4 inhibitor, SGLT2 inhibitor, GLP-1 receptor agonist, or basal insulin.123 Which medications you wind up using depends on your preference, medical history, and will take the goal of reducing blood glucose levels while minimizing side effects into consideration.
Here's an overview of each class of oral diabetes medications, along with info on how the class of drugs works; the generic and brand name drugs within the class; possible side effects; possible additional benefits; suggested dosing schedule, and a cost category.
What they do: block the breakdown of carbohydrates into sugar and slow glucose absorption.
Names: acarbose (Precose); miglitol (Glyset).
Possible side effects: gastrointestinal (flatulence, diarrhea).
Possible additional benefits: slow the rise in blood glucose levels after a meal; no hypoglycemia; decrease cardiovascular disease events.
Notes: must be taken with food, specifically before you take the first bite of a meal.
What they do: reduce the amount of glucose produced and released by the liver; makes muscle tissue more sensitive to insulin, allowing absorption of glucose).
Names: metformin (Glucophage).
Possible side effects: gastrointestinal symptoms (diarrhea, abdominal cramping).
Potential additional benefits: lower “bad” cholesterol levels.
Notes: usually taken 2 times a day with breakfast and dinner; side effects improve when taken with food; has been in use and studied for many years.
Multiple contraindications: chronic kidney disease (CKD), acidosis, hypoxia, dehydration.
Bile Acid Sequestrants
What they do: cholesterol-lowering medications that also reduce blood glucose levels in patients with diabetes.
Names: colesevelam (Welchol).
Possible side effects: gastrointestinal symptoms (flatulence, constipation); elevated triglyceride levels; decreased absorption of other medications.
Potential additional benefits: lower “bad” cholesterol levels (LDL); no hypoglycemia.
Notes: taken once or twice a day with a meal and liquid; may be safe for patients who cannot use other medications due to liver problems.
What they do: raise the amount of insulin in the body after a meal by allowing a naturally occurring compound (GLP-1) to remain active in the body longer.
Names: sitagliptin (Januvia); saxagliptin (Onglyza); linagliptin (Tradjenta); alogliptin (Nesina).
Possible side effects: severe joint pain; inflammation of the pancreas.
Possible additional benefits: low risk of hypoglycemia; does not tend to cause weight gain; help improve cholesterol levels; well tolerated.
Notes: taken once a day, at the same time every day.
What they do: stimulate beta cells to release insulin.
Names: repaglinide (Prandin), nateglinide (Starlix).
Possible side effects: hypoglycemia, weight gain.
Possible additional benefits: helps slow the rise in blood glucose levels after a meal; dosing flexibility.
Notes: taken before each of three meals.
What they do: block the reabsorption of glucose, eliminating excess glucose in the urine.
Names: canagliflozin (Invokana); empagliflozin (Jardiance);
Possible benefits: weight loss, decrease in blood pressure.
Possible side effects: urinary tract infections, yeast infections, dizziness, increase in bad cholesterol, acid build-up in the blood (ketoacidosis), risk of bone fractures (canagliflozin).
Notes: taken once or twice a day with a meal. Sulfonylureas have been in use since the 1950s.
What they do: stimulate beta cells to release more insulin.
Names: glipizide (Glucotrol, Glucotrol XL; glyburide (Micronase, Glynase); Glimepiride (Amaryl).
Possible side effects: hypoglycemia, weight gain, gastrointenstinal symptoms.
Possible benefits: decrease in microvascular risks; been in use for many years.
Notes: taken once daily, usually in the morning.
What they do: help insulin work beter and reduce glucose production in the liver.
Names: rosiglitazone (Avandia); pioglitazone (Actos).
Possible side effects: weight gain, edema, bone fractures, increase in LDL "bad" cholesterol.
Possible additional benefits: help slow the rise in blood glucose levels after a meal; increase in HDL "good cholesterol", lower triglycerides.
Notes: taken once per day, the same time every day; the first drug in this class—troglitazone (Rezulin) was pulled from the market due to cases of serious liver damage. The drugs currently in this class have not been shown to cause the same problems, however individuals are monitored closely.
*The information compiled in this article is based on the most current information available at the time of publication. We review this information on an annual basis, or more frequently as needed.
**Cost is based on the lowest costing member of the class.