Type 2 Diabetes Medications and Treatments

Type 2 diabetes is a relatively common condition—affecting 5-8% of adults—that causes high levels of sugar in the blood. Providers often recommend a combination of medication and lifestyle changes to manage the condition. This can help keep blood sugar at a safe level and prevent serious complications like vision loss and heart problems.

In this article, I’ll talk about the different types of medications used to treat diabetes, commonly prescribed drugs, and their benefits and side effects. I’ll also briefly discuss other type 2 diabetes treatment options.

Medications for Type 2 Diabetes

The following are the most common medications for type 2 diabetes. The best drug and dosage for you depends on a variety of factors, including your weight, average blood sugar levels, overall health, other health conditions, and medical history. 

Alpha glucosidase inhibitors

Although these medications were commonly used in the past, they are rarely prescribed now. This is because they don’t reduce blood sugar as effectively as other medications, and they cause a significant amount of side effects, in particular, digestive issues and diarrhea.

Some alpha glucosidase inhibitors include:

• Acarbose (Precose)
• Miglitol (Glyset)

Biguanides

These medications reduce the amount of sugar your liver produces and the amount of sugar your intestines absorb. Metformin, which is typically used as a first-line treatment for type 2 diabetes, is a biguanide. It has been used and studied for a long time, and it is generally very well tolerated. However, it can cause some side effects, most commonly, diarrhea and cramping.

In rare cases, metformin can cause people to develop acidosis (too much acid in the blood). This is a serious condition that can cause breathing problems, nausea, diarrhea, and other symptoms. For this reason, if you have kidney or heart issues or consume large amounts of alcohol, your provider probably won’t prescribe a biguanide.

Some other names for metformin include:

• Glucophage
• Hydrochloride ER
• Glumetza
• Riomet
• Fortamet

Dopamine agonist

Although dopamine agonists were developed to treat other conditions, they can also effectively treat diabetes. They stimulate the dopamine receptors in the brain. This increases insulin sensitivity, helping to control blood sugar levels. Providers usually prescribe bromocriptine (Cyloset).

Dipeptidyl peptidase-4 (DPP-4) inhibitors

Also known as gliptins, DPP-4 inhibitors lower blood sugar and help the pancreas produce more insulin. Although they effectively manage diabetes, they can cause side effects like headaches and digestive problems. Some DPP-4 inhibitors include:

• Linagliptin (Trajenta)
• Saxagliptin (Onglyza)
• Vildagliptin (Galvus)
• Sitagliptin (Januvia)

Glucagon-like peptide 1 receptor agonists (GLP-1 receptor agonists)

These medications are injections of hormones called incretins, which are very similar to the natural hormone incretin. They help your body produce and use more insulin. Additionally, they slow digestion and reduce appetite. The most common side effects are digestive problems and nausea, but these usually go away over time. Some GLP-1 receptor agonists include:

• Exenatide (Byetta)
• Liraglutide (Victoza)
• Lixisenatide (Lyxumia)
• Albiglutide (Eperzan)
• Dulaglutide (Trulicity)

Meglitinides

Meglitinides help the body produce more insulin after eating. In some cases, they can cause blood sugar to fall too low, so providers are careful when prescribing these. Some meglitinides include:

• Repaglinide (Prandin)
• Nateglinide (Starlix)

Sodium-glucose transporter (SGLT) 2 inhibitors

Also known as gliflozins, these medications stop the kidneys from storing glucose and encourage the body to eliminate glucose. They’ll make you pee out excess glucose in your urine. However, they can cause some side effects such as vaginal thrush and acidosis. Some SGLT2 inhibitors include:

• Dapagliflozin (Forxiga)
• Empagliflozin (Jardiance)
• Canagliflozin (Invokana)

Sulfonylureas

These medications are one of the oldest types of diabetes drugs still in use today. They stimulate the pancreas, helping your body to produce more insulin, which helps regulate blood sugar. While they’re generally well tolerated, they can cause weight gain and hypoglycemia, so most providers prescribe metformin before trying sulfonylureas. Some people also have allergic reactions to these drugs. Commonly prescribed sulfonylureas include:

• Glipizide (Glucotrol)
• Chlorpropamide (Diabinese)
• Glimepiride (Amaryl)
• Tolazamide (Tolinase)
• Glyburide (Glynase, Diabeta)

Thiazolidinediones

Also known as glitazones, these drugs lower the amount of glucose in the liver and help the body’s fat cells better use insulin. However, they can increase the risk of heart disease, so your provider won’t recommend this drug if you have a heart condition. If you do take this medication, they’ll likely schedule regular check-ups to monitor your heart function.

Other side effects of thiazolidinediones include water retention, weight gain, and bone fractures. They may also slightly increase the risk of bladder cancer. Because of these risks and side effects, pioglitazone (Actos) is the only glitazone still available.

Other Type 2 Diabetes Treatment Options

Not all people with diabetes need to, or should, take antidiabetic medications. The best treatment option for you depends on your:

• Age
• Overall health
• Pre-existing conditions
• Other medications
• Treatment goals

In addition to medications, you can manage diabetes with lifestyle modifications such as:

• Maintaining a moderate calorie deficit. While not everyone with type 2 diabetes needs to lose weight, research has shown that a low-calorie diet aiming to reduce body weight can improve diabetes symptoms and, in some cases, send diabetes into remission

• Eating a nutritious, balanced diet rich in fruits, vegetables, whole grains, and lean proteins.

• Limiting less nutritious options such as sugary foods, processed foods, and foods high in saturated fat and cholesterol.

• Getting regular exercise or movement. 

• If applicable, stopping smoking.

• If applicable, reducing your alcohol consumption.

If you have diabetes, you are more likely to have heart disease, high blood pressure, high cholesterol, and associated cardiovascular conditions. You may need to take other medications to manage these conditions. These can include:

• Aspirin to thin the blood and lower the risk of blood clots.

• Antihypertensives to treat high blood pressure.

• Cholesterol-lowering drugs, such as statins.

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