In May 2020, the authorities recommended that certain manufacturers of extended-release metformin pull some of their tablets from the U.S. market. This action followed the discovery of an unacceptable level of a likely carcinogen (a substance that may cause cancer) in select extended-release metformin tablets. If you take this medication now, contact a healthcare provider. They will tell you whether to continue your current medication or if you should obtain a new prescription.
Diabetes is a disorder that causes elevated levels of blood glucose (sugar) in the bloodstream.
This occurs when your body cannot produce or use the hormone insulin properly. Made by the pancreas, insulin helps your body process the sugar from the foods you consume.
There are two primary forms of diabetes: type 1 and type 2. Individuals with either form often require medications to help manage their blood sugar.
The specific medicines you use depend on the type of diabetes you have. Learn more about the treatment choices available.
Medications for type 2 diabetes
If you have type 2 diabetes, your body still creates insulin but doesn’t use it effectively. Your body may not produce enough insulin or may not respond to it adequately to keep blood glucose in a healthy range.
The aim of treatment for type 2 diabetes is to improve your body’s use of insulin or to eliminate excess glucose from the bloodstream.
Most drugs for type 2 diabetes are taken orally, though insulin or injectable therapies may also be prescribed. Some treatments combine more than one diabetes medication.
Insulin
Some people with type 2 diabetes will need insulin therapy. The same insulin types used in type 1 diabetes can also be used for type 2 diabetes.
A clinician may suggest the insulin varieties employed in type 1 diabetes for a person with type 2, depending on the insulin required and the degree of insulin deficiency. Discuss the different insulin options with your provider.
Alpha-glucosidase inhibitors
These agents help your body break down starchy foods and table sugar, which in turn lowers blood glucose levels.
They can cause hypoglycemia (low blood sugar). Your chance of low blood sugar may increase if these are taken alongside other diabetes medications. Therefore, it’s crucial to use them exactly as directed.
For best effect, take alpha-glucosidase inhibitors before meals. Examples include:
- acarbose
- miglitol (Glyset)
Biguanides
Biguanides reduce how much glucose your liver produces. They also lower glucose absorption in the intestines, assist muscles in taking up glucose, and increase insulin sensitivity.
The most widely used biguanide is metformin (Glumetza).
Metformin is regarded as the first-line oral therapy for type 2 diabetes. It can be combined with other agents for type 2 diabetes and is found in the following combination medications:
- metformin-alogliptin (Kazano)
- metformin/canagliflozin (Invokamet)
- metformin/dapagliflozin (Xigduo XR)
- metformin/empagliflozin (Synjardy)
- metformin/ertugliflozin (Segluromet)
- metformin/glipizide
- metformin/glyburide (Glucovance)
- metformin/linagliptin (Jentadueto, Jentadueto XR)
- metformin/pioglitazone (Actoplus Met, Actoplus Met XR)
- metformin/repaglinide
- metformin/saxagliptin
- metformin/sitagliptin (Janumet, Janumet XR)
Dopamine-2 agonist
Bromocriptine (Cycloset) is classified as a dopamine-2 agonist.
Its precise mechanism in treating type 2 diabetes is not fully understood. It may influence bodily rhythms and reduce insulin resistance.
Research suggests that dopamine-2 agonists may also benefit other related health issues, such as elevated cholesterol or weight control.
Dipeptidyl peptidase-4 (DPP-4) inhibitors
DPP-4 inhibitors help lower blood sugar without typically causing hypoglycemia.
DPP-4 inhibitors block the DPP-4 enzyme, which normally breaks down a hormone called incretin. Incretins stimulate insulin production when needed and reduce glucose output from the liver when it isn’t required.
These medications can also enhance pancreatic insulin production.
Examples include:
- alogliptin (Nesina)
- alogliptin/metformin (Kazano)
- linagliptin (Tradjenta)
- linagliptin/empagliflozin (Glyxambi)
- linagliptin/metformin (Jentadueto, Jentadueto XR)
- saxagliptin (Onglyza)
- saxagliptin/metformin
- sitagliptin (Januvia)
- sitagliptin/metformin (Janumet and Janumet XR)
- sitagliptin/simvastatin
Glucagon-like peptide-1 receptor agonists (GLP-1 receptor agonists)
GLP-1 receptor agonists mimic incretin. A clinician may prescribe them alongside diet and exercise to help achieve improved glycemic control.
GLP-1 receptor agonists boost insulin use and promote growth of pancreatic beta cells. They reduce appetite and lower glucagon levels.
They also slow gastric emptying, which can enhance nutrient absorption from food while helping you maintain or lose weight.
These effects are particularly valuable for people managing diabetes.
When atherosclerotic cardiovascular disease, heart failure, or chronic kidney disease are primary concerns, the American Diabetes Association (ADA) recommends certain GLP-1 receptor agonists as part of glucose-lowering strategies.
Examples include:
- dulaglutide (Trulicity)
- exenatide (Byetta)
- exenatide extended-release (Bydureon BCise)
- liraglutide (Saxenda, Victoza)
- lixisenatide
- semaglutide (Ozempic)
- tirzepatide (Mounjaro)
Meglitinides
Meglitinides stimulate the pancreas to release insulin, but they’re not suitable for everyone. In certain cases, particularly with advanced kidney disease, they can cause your blood sugar to drop too low.
Examples are:
- nateglinide (Starlix)
- repaglinide (Prandin)
Sodium-glucose transport protein 2 (SGLT2) inhibitors
SGLT2 inhibitors prevent the kidneys from reabsorbing glucose, so excess sugar is eliminated in the urine.
Again, when atherosclerotic cardiovascular disease, heart failure, or chronic kidney disease are the dominant issues, the ADA suggests SGLT2 inhibitors as a treatment option. Examples include:
- canagliflozin (Invokana)
- canagliflozin/metformin (Invokamet, Invokamet XR)
- dapagliflozin (Farxiga)
- dapagliflozin/metformin (Xigduo XR)
- dapagliflozin/saxagliptin (Qtern)
- empagliflozin (Jardiance)
- empagliflozin/linagliptin (Glyxambi)
- empagliflozin/linagliptin-metformin (Trijardy XR)
- empagliflozin/metformin (Synjardy, Synjardy XR)
- ertugliflozin (Steglatro)
Sulfonylureas
These long-standing diabetes medications stimulate pancreatic beta cells to produce more insulin.
Examples include:
- glimepiride (Amaryl)
- glimepiride/pioglitazone (Duetact)
- gliclazide
- glipizide
- glipizide ER (Glipizide XL, Glucotrol XL)
- glipizide/metformin
- glyburide (Glynase)
- glyburide/metformin
Thiazolidinediones
Thiazolidinediones lower liver glucose production and help fat cells respond better to insulin, improving insulin resistance.
These drugs carry an elevated risk of heart-related problems. If your clinician prescribes one, they will monitor cardiac function while you are on the medication.
Options include:
- pioglitazone/alogliptin (Oseni)
- pioglitazone/glimepiride (Duetact)
- pioglitazone/metformin (Actoplus Met, Actoplus Met XR)
- rosiglitazone
Other drugs
People with type 1 or type 2 diabetes often need additional medications to manage conditions that commonly accompany diabetes.
These medicines can include:
- aspirin for cardiovascular protection
- drugs to manage high cholesterol
- medications for high blood pressure
Talk with a doctor
There are many medications available for both type 1 and type 2 diabetes, each working differently to help control blood glucose.
Ask a healthcare professional which diabetes medication might suit you best. They can provide recommendations based on your diabetes type, overall health, and other factors.
It’s also important to realize that new diabetes treatments are continually being researched and evaluated for approval.
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