An inhaled form was briefly licensed but was subsequently withdrawn. Insulin sensitizers address the core problem in type 2 diabetes — insulin resistance. Biguanides reduce hepatic glucose output and increase uptake of glucose by the periphery, including skeletal muscle.

Although it must be used with caution in patients with impaired liver or kidney function, metformin , a biguanide, has become the most commonly used agent for type 2 diabetes in children and teenagers. Among common diabetic drugs, metformin is the only widely used oral drug that does not cause weight gain.

Typical reduction in glycated hemoglobin A1C values for metformin is 1. Metformin is usually the first-line medication used for treatment of type 2 diabetes. In general, it is prescribed at initial diagnosis in conjunction with exercise and weight loss, as opposed to in the past, where it was prescribed after diet and exercise had failed.

There is an immediate-release as well as an extended-release formulation, typically reserved for patients experiencing gastrointestinal side-effects. It is also available in combination with other oral diabetic medications.

Thiazolidinediones TZDs , also known as "glitazones," bind to PPARγ , peroxisome proliferator activated receptor γ , a type of nuclear regulatory protein involved in transcription of genes regulating glucose and fat metabolism. These PPARs act on peroxisome proliferator responsive elements PPRE.

The final result is better use of glucose by the cells. These drugs also enhance PPAR-α activity and hence lead to a rise in HDL and some larger components of LDL. Typical reductions in glycated hemoglobin A1C values are 1. Some examples are:. Multiple retrospective studies have resulted in a concern about rosiglitazone's safety, although it is established that the group, as a whole, has beneficial effects on diabetes.

The greatest concern is an increase in the number of severe cardiac events in patients taking it. The ADOPT study showed that initial therapy with drugs of this type may prevent the progression of disease, [13] as did the DREAM trial.

However, they are less preferred than GLP-1 agonists or SGLT2 inhibitors, especially in patients with cardiovascular disease which liraglutide , empagliflozin , and canagliflozin are all FDA approved to treat. Concerns about the safety of rosiglitazone arose when a retrospective meta-analysis was published in the New England Journal of Medicine.

The meta-analysis was not supported by an interim analysis of the trial designed to evaluate the issue, and several other reports have failed to conclude the controversy.

This weak evidence for adverse effects has reduced the use of rosiglitazone, despite its important and sustained effects on glycemic control.

In contrast, at least one large prospective study, PROactive 05, has shown that pioglitazone may decrease the overall incidence of cardiac events in people with type 2 diabetes who have already had a heart attack.

The LYN kinase activator tolimidone has been reported to potentiate insulin signaling in a manner that is distinct from the glitazones. Secretagogues are drugs that increase output from a gland, in the case of insulin from the pancreas. Sulfonylureas were the first widely used oral anti-hyperglycemic medications.

They are insulin secretagogues , triggering insulin release by inhibiting the K ATP channel of the pancreatic beta cells. Eight types of these pills have been marketed in North America, but not all remain available. The "second-generation" drugs are now more commonly used. They are more effective than first-generation drugs and have fewer side-effects.

All may cause weight gain. Current clinical practice guidelines from the AACE rate sulfonylureas as well as glinides below all other classes of antidiabetic drugs in terms of suggested use as first, second, or third line agents - this includes bromocriptine , the bile acid sequestrant colesevelam , α-glucosidase inhibitors , TZDs glitazones , and DPP-4 inhibitors gliptins.

Sulfonylureas bind strongly to plasma proteins. Sulfonylureas are useful only in type 2 diabetes, as they work by stimulating endogenous release of insulin. They work best with patients over 40 years old who have had diabetes mellitus for under ten years.

They cannot be used with type 1 diabetes, or diabetes of pregnancy. They can be safely used with metformin or glitazones.

The primary side-effect is hypoglycemia , which appears to happen more commonly with sulfonylureas than with other treatments. A Cochrane systematic review from showed that treatment with Sulphonylurea did not improve control of glucose levels more than insulin at 3 nor 12 months of treatment.

Typical reductions in glycated hemoglobin A1C values for second-generation sulfonylureas are 1. Meglitinides help the pancreas produce insulin and are often called "short-acting secretagogues.

They are taken with or shortly before meals to boost the insulin response to each meal. If a meal is skipped, the medication is also skipped. Typical reductions in glycated hemoglobin A1C values are 0. Alpha-glucosidase inhibitors are "diabetes pills" but not technically hypoglycemic agents because they do not have a direct effect on insulin secretion or sensitivity.

These agents slow the digestion of starch in the small intestine, so that glucose from the starch of a meal enters the bloodstream more slowly, and can be matched more effectively by an impaired insulin response or sensitivity. These agents are effective by themselves only in the earliest stages of impaired glucose tolerance , but can be helpful in combination with other agents in type 2 diabetes.

These medications are rarely used in the United States because of the severity of their side-effects flatulence and bloating.

They are more commonly prescribed in Europe. They do have the potential to cause weight loss by lowering the amount of sugar metabolized. Incretins are also insulin secretagogues.

The two main candidate molecules that fulfill criteria for being an incretin are glucagon-like peptide-1 GLP-1 and gastric inhibitory peptide glucose-dependent insulinotropic peptide, GIP. Both GLP-1 and GIP are rapidly inactivated by the enzyme dipeptidyl peptidase-4 DPP Glucagon-like peptide GLP agonists bind to a membrane GLP receptor.

Endogenous GLP has a half-life of only a few minutes, thus an analogue of GLP would not be practical. As of , the AACE lists GLP-1 agonists, along with SGLT2 inhibitors, as the most preferred anti-diabetic agents after metformin.

Liraglutide in particular may be considered first-line in diabetic patients with cardiovascular disease, as it has received FDA approval for reduction of risk of major adverse cardiovascular events in patients with type 2 diabetes.

These agents may also cause a decrease in gastric motility, responsible for the common side-effect of nausea, which tends to subside with time. GLP-1 analogs resulted in weight loss and had more gastrointestinal side-effects, while in general dipeptidyl peptidase-4 DPP-4 inhibitors were weight-neutral and increased risk for infection and headache, but both classes appear to present an alternative to other antidiabetic drugs.

DPP-4 inhibitors increase blood concentration of the incretin GLP-1 by inhibiting its degradation by DPP DPP-4 inhibitors lowered hemoglobin A1C values by 0. A result in one RCT comprising patients aged 65 or older mean baseline HgbA1c of 7.

Amylin agonist analogues slow gastric emptying and suppress glucagon. They have all the incretins actions except stimulation of insulin secretion. As of [update] , pramlintide is the only clinically available amylin analogue.

Like insulin, it is administered by subcutaneous injection. The most frequent and severe adverse effect of pramlintide is nausea , which occurs mostly at the beginning of treatment and gradually reduces. Typical reductions in A1C values are 0. SGLT2 inhibitors block the sodium-glucose linked transporter 2 proteins in renal tubules of nephrons in kidneys, reabsorption of glucose in into the renal tubules, promoting excretion of glucose in the urine.

This causes both mild weight loss, and a mild reduction in blood sugar levels with little risk of hypoglycemia. They may be considered first line in diabetic patients with cardiovascular disease, especially heart failure , as these medications have been shown to reduce the risk of hospitalization in patients with such comorbidities.

Furthermore, there has been growing evidence that the effectiveness and safety of this drug class could depend on genetic variability of the patients. The side effects of SGLT2 inhibitors are derived directly from their mechanism of action; these include an increased risk of: ketoacidosis , urinary tract infections , candidal vulvovaginitis , and hypoglycemia.

The following table compares some common anti-diabetic agents, generalizing classes, although there may be substantial variation in individual drugs of each class.

When the table makes a comparison such as "lower risk" or "more convenient" the comparison is with the other drugs on the table. Many anti-diabetes drugs are available as generics. These include: [49]. No generics are available for dipeptidyl peptidase-4 inhibitors Onglyza , the glifozins, the incretins and various combinations.

Sitagliptin patent expired in July , leading to launch of generic sitagliptin [50] brands. This lowered the cost of therapy for type 2 diabetes using sitagliptin. The effect of Ayurvedic treatments has been researched, however due to methodological flaws of relevant studies and research, it has not been possible to draw conclusions regarding efficacy of these treatments and there is insufficient evidence to recommend them.

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Wikimedia Commons. Drugs that lower blood glucose levels to treat diabetes. This article is about treatment of diabetes mellitus. For treatment of diabetes insipidus, see Diabetes insipidus. Main article: Insulin medication.

Main article: Biguanide. Main article: Thiazolidinedione. This section does not cite any sources. Please help improve this section by adding citations to reliable sources. Unsourced material may be challenged and removed.

January Learn how and when to remove this template message. Main article: Sulfonylurea. Main article: Meglitinide. Main article: Alpha-glucosidase inhibitor. This section needs additional citations for verification.

Please help improve this article by adding citations to reliable sources in this section. Main article: Dipeptidyl peptidase-4 inhibitor. Main article: Gliflozin.

Front Pharmacol. doi : PMC PMID In Longo DL, Fauci AS , Kasper DL, Hauser SL, Jameson JL, Loscalzo J eds. Harrison's Principles of Internal Medicine 18th ed.

ISBN In Feingold KR, Anawalt B, Boyce A, Chrousos G eds. com, Inc. Retrieved November 16, The Cochrane Database of Systematic Reviews. Step-Up to Medicine Step-Up Series.

Diabetes Care. Xigduo XR combines metformin with dapagliflozin. Dapagliflozin blocks some of the glucose in your body from reentering your blood through your kidneys.

This causes your body to get rid of more glucose through your urine. Synjardy , which is also available as Synjardy XR and comes as an oral tablet, was approved for use in It combines the drugs metformin and empagliflozin. Empagliflozin works in a similar way to dapagliflozin.

Glyxambi , which comes as an oral tablet, was approved for use in It combines the drugs linagliptin and empagliflozin. Linagliptin blocks the breakdown of certain hormones in your body that tell your pancreas to make and release insulin.

It also slows your digestion, which slows the release of glucose into your blood. Steglujan, which comes as an oral tablet, was approved in late It combines ertugliflozin and sitagliptin. Sitagliptin blocks the breakdown of certain hormones in your body that tell your pancreas to make and release insulin.

It also slows your digestion , which slows the absorption of glucose into your blood. Segluromet, which comes as an oral tablet, was approved in late It combines ertugliflozin and metformin.

Steglatro , which comes as an oral tablet, was approved in late It works through the same mechanism as empagliflozin. These new brand-name injectables are not available as generic drugs.

These drugs contain a type of insulin, a GLP-1 agonist , or both. Glucagon-like peptide-1 GLP-1 receptor agonists help your pancreas release more insulin when your glucose level is high. They also slow down glucose absorption during digestion.

Tresiba , which was approved in , is a brand-name version of the drug insulin degludec. Tresiba is a long-acting insulin that lasts up to 42 hours.

This is longer than commonly used insulin. Basaglar and Toujeo are two new forms of insulin glargine. Basaglar is a long-acting insulin drug that was approved in It lasts for 24 hours. Toujeo is a more concentrated form of insulin glargine. It was approved for use in and lasts for 36 hours. Xultophy was approved in Xultophy is injected once per day.

Soliqua was approved in Ozempic was approved in late Ozempic and Rybelsus are a brand-name version of the GLP-1 agonist called semaglutide. Adlyxin was approved in Adlyxin is a brand-name version of the GLP-1 agonist called lixisenatide. In addition to these new medications, several diabetes drugs are currently in development.

These drugs include:. Some of these drugs are components of the new combination medications listed above, as well as the older combination medications listed below. The following groups of drugs are commonly used to treat type 2 diabetes.

All come as oral tablets. Metformin also comes as an oral solution. Metformin is often the first drug used to treat type 2 diabetes. It works by slowing glucose production in your liver.

It also makes your body tissues more sensitive to insulin, which helps the tissues absorb glucose. Metformin is also combined with other oral medications to reduce the number of tablets you need to take.

These drugs slow or block the breakdown of carbohydrates in your body. Carbohydrates are in starchy or sugary foods. This action slows the absorption of glucose into your bloodstream. These drugs block the breakdown of certain hormones in your body that tell your pancreas to make and release insulin.

These drugs also slow your digestion, which slows the release of glucose into your blood. These drugs block some of the glucose in your system from reentering your blood through your kidneys. They also cause your body to get rid of more glucose through your urine.

These drugs, such as pioglitazone, make your body tissues more sensitive to insulin. This helps your body use more of the glucose in your blood.

In addition to the new ones listed above, several combination medications have been available for a while. Older combination medications include the following:.

It can be used to treat type 1 or type 2 diabetes. Different types of insulin are available. Some types act quickly. These types help control your blood glucose level at mealtime.

Other types act over a longer period. These types control your blood glucose level throughout the day and night. The amylin analogue called pramlintide is taken before a meal.

DPP-4 inhibitors lowered hemoglobin A1C values by 0. A result in one RCT comprising patients aged 65 or older mean baseline HgbA1c of 7. Amylin agonist analogues slow gastric emptying and suppress glucagon.

They have all the incretins actions except stimulation of insulin secretion. As of [update] , pramlintide is the only clinically available amylin analogue. Like insulin, it is administered by subcutaneous injection. The most frequent and severe adverse effect of pramlintide is nausea , which occurs mostly at the beginning of treatment and gradually reduces.

Typical reductions in A1C values are 0. SGLT2 inhibitors block the sodium-glucose linked transporter 2 proteins in renal tubules of nephrons in kidneys, reabsorption of glucose in into the renal tubules, promoting excretion of glucose in the urine.

This causes both mild weight loss, and a mild reduction in blood sugar levels with little risk of hypoglycemia. They may be considered first line in diabetic patients with cardiovascular disease, especially heart failure , as these medications have been shown to reduce the risk of hospitalization in patients with such comorbidities.

Furthermore, there has been growing evidence that the effectiveness and safety of this drug class could depend on genetic variability of the patients.

The side effects of SGLT2 inhibitors are derived directly from their mechanism of action; these include an increased risk of: ketoacidosis , urinary tract infections , candidal vulvovaginitis , and hypoglycemia.

The following table compares some common anti-diabetic agents, generalizing classes, although there may be substantial variation in individual drugs of each class. When the table makes a comparison such as "lower risk" or "more convenient" the comparison is with the other drugs on the table.

Many anti-diabetes drugs are available as generics. These include: [49]. No generics are available for dipeptidyl peptidase-4 inhibitors Onglyza , the glifozins, the incretins and various combinations.

Sitagliptin patent expired in July , leading to launch of generic sitagliptin [50] brands. This lowered the cost of therapy for type 2 diabetes using sitagliptin.

The effect of Ayurvedic treatments has been researched, however due to methodological flaws of relevant studies and research, it has not been possible to draw conclusions regarding efficacy of these treatments and there is insufficient evidence to recommend them.

Contents move to sidebar hide. Article Talk. Read Edit View history. Tools Tools. What links here Related changes Upload file Special pages Permanent link Page information Cite this page Get shortened URL Download QR code Wikidata item.

Download as PDF Printable version. In other projects. Wikimedia Commons. Drugs that lower blood glucose levels to treat diabetes. This article is about treatment of diabetes mellitus. For treatment of diabetes insipidus, see Diabetes insipidus.

Main article: Insulin medication. Main article: Biguanide. Main article: Thiazolidinedione. This section does not cite any sources. Please help improve this section by adding citations to reliable sources. Unsourced material may be challenged and removed. January Learn how and when to remove this template message.

Main article: Sulfonylurea. Main article: Meglitinide. Main article: Alpha-glucosidase inhibitor. This section needs additional citations for verification. Please help improve this article by adding citations to reliable sources in this section. Main article: Dipeptidyl peptidase-4 inhibitor.

Main article: Gliflozin. Front Pharmacol. doi : PMC PMID In Longo DL, Fauci AS , Kasper DL, Hauser SL, Jameson JL, Loscalzo J eds. Harrison's Principles of Internal Medicine 18th ed. ISBN In Feingold KR, Anawalt B, Boyce A, Chrousos G eds.

com, Inc. Retrieved November 16, The Cochrane Database of Systematic Reviews. Step-Up to Medicine Step-Up Series.

Diabetes Care. Archived from the original on December 9, Archived from the original on March 3, Retrieved May 6, Wired News. Archived from the original on December 4, Retrieved June 21, Retrieved September 21, Archived from the original on December 2, January Endocrine Practice.

The New England Journal of Medicine. Archived from the original on March 18, Expert Opinion on Drug Safety. S2CID Journal of the American College of Cardiology. Molecular and Cellular Biology. June 13, Archived from the original on August 12, Archived from the original on September 27, Expert Opinion on Pharmacotherapy.

International Journal of Clinical Practice. Archived from the original on December 15, Retrieved January 23, Archived from the original on July 23, Retrieved February 9, Archived from the original on February 5, Archived from the original on June 18, Archived from the original on January 9, Archived from the original on January 29, Retrieved March 7, Current Medical Research and Opinion.

Journal of the American Geriatrics Society. Drug Design, Development and Therapy. Archived from the original on November 29, Retrieved August 26, Pharmacogenetics of new classes of antidiabetic drugs. Bosn J of Basic Med Sci. Archived from the original on August 27, The European Respiratory Journal.

Best Buy Drugs. Consumer Reports : Archived PDF from the original on February 27, Retrieved September 18, An Update" PDF.

Comparative Effectiveness Review. number 27 AHRQ Pub. Archived from the original PDF on September 27, Retrieved November 28, Bennett WL, Maruthur NM, Singh S, Segal JB, Wilson LM, Chatterjee R, et al. May Annals of Internal Medicine. Archived PDF from the original on June 15, Retrieved July 17, January 31, Retrieved January 31, Cochrane Metabolic and Endocrine Disorders Group December The Cochrane Database of Systematic Reviews 12 : CD Oral diabetes medication , insulins and insulin analogs , and other drugs used in diabetes A Insulin aspart Insulin glulisine Insulin lispro.

Regular insulin. Cagrilintide § Pramlintide. No weight gain; Lower doses used if kidney problems Linagliptin. Dose: Taken once daily SE: runny nose, sore throat, rare reports of pancreatitis, rare severe allergic reactions, no weight gain; SGLT2 inhibitors: increase glucose excretion in the urine Canagliflozin.

Dose: Taken once daily Same as above with metformin and saxagliptin. Table is prepared with information from package inserts of the various medications and opinion of the UCSF Diabetes Teaching Center. This table is not meant to be all inclusive and contains important educational information, as viewed by the UCSF Diabetes Teaching Center.

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Diagnosing Diabetes Treatment Goals What is Type 2 Diabetes? Home » Types Of Diabetes » Type 2 Diabetes » Treatment Of Type 2 Diabetes » Medications And Therapies » Type 2 Non Insulin Therapies » Table of Medications. Use this table to look up the different medications that can be used to treat type 2 diabetes.

Use the links below to find medications within the table quickly, or click the name of the drug to link to expanded information about the drug.

Tolbutamide Orinase® various generics. SE: hypoglycemia, weight gain Preferred SFU for elderly Must be taken times daily. Glimepiride Amaryl® various generics. Initial: mg daily Range: mg Dose: Taken once daily.

SE: hypoglycemia, weight gain Need to take only once daily. Glipizide Glucotrol® Glucotrol XL® various generics. Initial: 5 mg daily Range: 2. Glyburide Micronase®, DiaBeta® various generics.

Initial: 2. Glyburide, micronized Glynase PresTab® various generics. Initial: 1. Initial: mg daily 0. SE: hypoglycemia Safe for elderly Duration of action is only 4 hours Take within minutes of meal.

Initial: mg three times daily if A1C close to goal, use 60 mg Range: mg Dose: Taken three times daily. SE: hypoglycemia Safe for elderly Duration of action is only 2 hours Take within 30 minutes of meal. Glucophage: mg, mg, mg tablets Glucophage XR: mg, mg tablets Fortamet: mg, mg tablets Glumetza: mg, mg tablets Generic metformin ER: mg, mg tablets.

Initial: mg twice daily or mg once daily Range: mg Dose: Taken two or three times daily ER: Initial: mg once daily Range: mg Dosed once daily. Acarbose Precose® various generics. SE: flatulence Take with first bite of meal Start with low dose and slowly ­ to minimize GI intolerance.

Pioglitazone preferred over rosiglitazone Actos®. SE: anemia, swelling edema from fluid retention, weight gain, macular edema in eye , bone loss and fractures in women May cause or worsen heart failure Cannot use if have liver problems or severe heart failure Requires liver monitoring 6.

Initial: 4 mg daily Range: mg Dose: Taken once or twice daily. SE: anemia, swelling edema from fluid retention, weight gain, macular edema in eye , bone loss and fractures in women May increase­ risk of heart problems such as heart-related chest pain angina or heart attack myocardial infarction May cause or worsen heart failure Cannot use if have liver problems or severe heart failure Requires liver monitoring 6.

GLP-1 ANALOGS: increase insulin secretion, reduce glucose release from liver after meals, delay food emptying from stomach and promote satiety.

Initial: 5 mcg SQ twice daily Range: up to 10 mcg SQ twice daily Dose: Taken twice daily. SE: nausea, headache, hypoglycemia when used with insulin secretagogues Rare reports of sudden pancreatitis inflammation of pancreas May cause mild weight loss.