Oral Medications Used for Treatment of Type 2 Diabetes
Drugs delaying glucose absorption from small intestine: acarbose (Precose®) and miglitol (Glyset®). These are used at mealtime to lower after-meal hyperglycemia (high sugar).
Drugs increasing insulin secretion
Short-acting: repaglinide (Prandin®) and nateglinide (Starlix®). These are used at mealtime to reduce after-meal sugar levels.
Long-acting: sulfonylureas, such as glipizide (Glucotrol®), glyburide (Micronase®, Diaßeta®) and glimepiride (Amaryl®). These medications are used once or twice daily to lower overall, but especially overnight, sugar levels. They have to be used carefully because they can lower blood glucose too much and cause hypoglycemic (low-sugar) reactions.
Drugs improving insulin action
Biguanides: metformin (Glucophage®) affects the way insulin works on the liver to decrease the amount of sugar the liver makes overnight. Metformin should not be used in patients with kidney failure.
Thiazolidinediones – (also called glitazones or TZDs) – rosiglitazone (Avandia®) and pioglitazone (Actos®) – help insulin to work especially on muscles and fat. They are long-acting, used once a day. They cannot be used when the patient has severe congestive heart failure.
Drugs preserving the “incretin” effect
DPP-4 inhibitors. These pills inhibit the action of an enzyme (DPP-4) which breaks down “incretins” (see below). This allows your own incretins work longer and enables the pancreatic islet cells to make more insulin and less glucagon when you eat. As a consequence, glucose levels are lowered.
Sitagliptin (Januvia®), saxagliptin (Onglyza®), linagliptin (Tradjenta®) and alogliptin (Nesina®) are representing this class on the U.S. market.
Drugs which lower both glucose and cholesterol
Colesevelam (Welchol®) lowers both blood sugar and “bad” (LDL) cholesterol. It works by binding bile acids but it’s not clear exactly how that lowers glucose.
Drugs with central nervous system effects
Cycloset® (bromocriptine QR) is a pill which works at the level of the brain; it improves insulin action, does not cause hypoglycemia nor weight gain and might have beneficial cardiovascular effects.
Drugs which make kidneys excrete glucose in the urine
These medications block the normal ability of the kidneys to re-absorb all the glucose from the urine back into the bloodstream (normally, we don’t have any sugar in the urine). In patients with diabetes, these pills lower blood sugar by making patients excrete it in their urine. There are four such pills now approved by the FDA: canagliflozin (Invokana®), dapagliflozin (Farxiga®), empagliflozin (Jardiance®) and ertugliflozin (Steglatro®).
Drugs combining effects
These medications combine the insulin-action improving and insulin-secreting effects of the above-mentioned drugs.
- Avandamet® (combination of Avandia and metformin)
- Avandaryl® (combination of Avandia and glimepiride)
- Glucovance® (combination of glyburide and metformin)
- Metaglip® (combination of glipizide and metformin)
- ACTOplus Met® (combination of Actos and metformin)
- Duetact® (combination of Actos and glimepiride)
- PrandiMet® (combination of Prandin and metformin)
- JanuMet® (combination of Januvia and metformin)
- Kombiglyze XR® (combination of Onglyza and metformin)
- Jentadueto® (combination of Tradjenta and metformin)
- Kazano® (combination of Nesina and metformin)
- Oseni® (combination of Nesina and pioglitazone)
- Invokamet® (combination of Invokana and metformin)
- Synjardy® (combination of Jardiance and metformin)
- Glyxambi® (combination of Jardiance and Tradjenta)
- Xigduo® (combination of Farxiga and metformin)
- Qtern® (combination of Farxiga and Onglyza)
- Steglujan® (combination of Steglatro and Januvia)