Diabetes treatment: Medications for type 2 diabetes

Healthy lifestyle choices — including diet, exercise and weight control — provide the foundation for managing type 2 diabetes. However, you may need medications to achieve target blood sugar (glucose) levels. Sometimes a single medication is effective. In other cases, a combination of medications works better.

The list of medications for type 2 diabetes is long and potentially confusing. Learning about these drugs — how they’re taken, what they do and what side effects they may cause — will help you discuss treatment options with your doctor.

Diabetes treatment: Lowering blood sugar

Several classes of type 2 diabetes medicines exist. Each class of medicine works in different ways to lower blood sugar. A drug may work by:

• Stimulating the pancreas to produce and release more insulin
• Inhibiting the production and release of glucose from the liver
• Blocking the action of stomach enzymes that break down carbohydrates
• Improving the sensitivity of cells to insulin
• Inhibiting the reabsorption of glucose in the kidneys
• Slowing how quickly food moves through the stomach

Each class of medicine has one or more drugs. Some of these drugs are taken orally, while others must be injected.

Compare diabetes medications

Here’s an at-a-glance comparison of common diabetes medications. More medications are available depending on your needs and situation. Ask your doctor about your options and the pros and cons of each.

Oral medications

Meglitinides

Medications

Action

• Stimulate the release of insulin

Advantages

Possible side effects

• Low blood sugar (hypoglycemia)
• Weight gain
• Nausea or vomiting, when interacting with alcohol

Sulfonylureas

Medications

• Glipizide (Glucotrol)
• Glimepiride (Amaryl)
• Glyburide (DiaBeta, Glynase)

Action

• Stimulate the release of insulin

Advantages

• Low cost
• Effective in lowering blood sugar

Possible side effects

• Hypoglycemia
• Weight gain
• Skin rash

Dipeptidyl-peptidase 4 (DPP-4) inhibitors

Medications

• Saxagliptin (Onglyza)
• Sitagliptin (Januvia)
• Linagliptin (Tradjenta)
• Alogliptin (Nesina)

Action

• Stimulate the release of insulin when blood glucose is rising
• Inhibit the release of glucose from the liver

Advantages

• Don’t cause weight gain
• Don’t cause hypoglycemia (unless combined with insulin or a sulfonylurea)

Possible side effects

• Upper respiratory tract infection
• Sore throat
• Headache

Biguanides

Medications

• Metformin (Glumetza, Riomet, Fortamet)

Action

• Inhibit the release of glucose from the liver
• Improve sensitivity to insulin

Advantages

• Very effective
• May promote modest weight loss
• Low cost

Possible side effects

• Nausea
• Diarrhea
• Very rarely, the harmful buildup of lactic acid (lactic acidosis) when used in people with kidney or liver failure

Thiazolidinediones

Medications

• Rosiglitazone (Avandia)
• Pioglitazone (Actos)

Action

• Improve sensitivity to insulin
• Inhibit the release of glucose from the liver

Advantages

• May slightly increase high-density lipoprotein (HDL) cholesterol, the “good” cholesterol

Possible side effects

• Weight gain
• Heart failure
• Heart attack
• Fractures
• Possible increased risk of bladder cancer with pioglitazone

These medications shouldn’t be used in people with kidney disease or heart problems.

Alpha-glucosidase inhibitors

Medications

• Acarbose
• Miglitol (Glyset)

Action

• Slow the breakdown of starches and some sugars

Advantages

• Don’t cause weight gain
• Don’t cause hypoglycemia (unless combined with insulin or a sulfonylurea)

Possible side effects

• Stomach pain
• Gas
• Diarrhea

Sodium-glucose co-transporter 2 (SGLT2) inhibitors

Medications

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

Action

• Block glucose from being reabsorbed by the kidneys

Advantages

• May promote weight loss
• May lower blood pressure

Possible side effects

• Urinary tract infections
• Yeast infections
• Rare, serious genital infection

Bile acid sequestrants

Medications

Action

• Lower cholesterol and have a very modest effect in lowering blood glucose when used in combination with other diabetes medications

Advantages

• Likely safe for people with liver problems

Possible side effects

• Gas
• Constipation
• Indigestion

Injectable medications

Amylin mimetics

Medications

Action

• Help regulate glucose
• Slow food moving through the stomach
• Used with insulin injections

Advantages

• May suppress hunger
• May promote modest weight loss

Possible side effects

• Hypoglycemia
• Nausea or vomiting

Incretin mimetics (GLP-1 analogs)

Medications

• Albiglutide (Tanzeum)
• Dulaglutide (Trulicity)
• Exenatide (Byetta)
• Exenatide extended release (Bydureon)
• Liraglutide (Saxenda, Victoza)
• Lixisenatide (Adlyxin)
• Semaglutide (Ozempic, Rybelsus)

Action

• Stimulate the release of insulin
• Used with metformin, basal insulin or a sulfonylurea

Advantages

• May suppress hunger
• May promote modest weight loss

Possible side effects

• Nausea or vomiting
• Increased risk of inflamed pancreas (pancreatitis) and some thyroid tumors

How to choose your diabetes medication

No single diabetes treatment is best for everyone, and what works for one person may not work for another. Your doctor can determine how a specific medication or multiple medications may fit into your overall diabetes treatment plan and help you understand the advantages and disadvantages of specific diabetes drugs.