The first approach for managing type 2 diabetes is a change in diet and exercise. But the primary goal of any diabetes treatment regimen is to decrease and maintain A1c levels over time, which in turn reduces the long-term complications of diabetes.
Oral diabetes medications are the next level of defense in the fight to control A1c. Over 70 percent of adults diagnosed with diabetes in the U.S. are taking oral medications to control blood sugar.
In order to have the best results with any oral medication you might be prescribed, you should have an understanding of each class of drugs available for treatment.
How they work
Each class has its own method of action to control blood sugar levels as well as dosing options, benefits, and side effects. Work with your doctor to understand which medication will best address your blood sugar management.
The top eight drug classes used to control blood sugars
1. Sulfonylureas: Glimepiride, Glyburide, Glipizide
These drugs are known as secretagogues, and they primarily work by stimulating the beta cells of the pancreas to release more insulin. One important side effect is that they can cause hypoglycemia, or low blood sugar, so it is important to always have a source of carbohydrates available.
2. Meglitinides: Repaglinide, Nateglinide
Meglitinides are another class of secretagogues that have shown a lesser tendency toward hypoglycemia.
3. Biguanides: Metformin, Metformin Extended Release
This is a class of insulin sensitizers which works to decrease the amount of glucose produced by the liver.
4. Thiazolidinediones: Pioglitazone, Rosiglitazone
Another sensitizer, thiazolidinediones work by making the muscle and fat tissues more sensitive to the effects of insulin.
5. DPP-4 inhibitors: Sitagliptin, Saxagliptin, Linagliptin, Alogliptin
This new class of glucose control medications prevents the breakdown of GLP-1 in the body. GLP-1 reduces blood glucose, but breaks down quickly; these drugs allow it to stick around a little longer.
6. SGLT2 inhibitors: Canagliflozin, Dapagliflozin
Another new class of medications, the SGLT2 inhibitors work by blocking the reabsorption of glucose as blood passes through the kidneys.
7. Alpha-glucosidase inhibitors: Miglitol, Acarbose
These medications work in the digestive tract by slowing the rise in blood glucose that occurs while eating. Alpha-glucosidase inhibitors work by blocking the breakdown of carbohydrates in the intestines.
8. Bile Acid Sequestrants: Colesevelam
This cholesterol-lowering medication has been shown to also reduce blood glucose levels; however, the mechanism of action is not yet clearly understood.
There are other factors to consider when determining the best choices for diabetes medications. For instance, if you have a restrictive schedule, you should know that most of these drugs are taken one to two times daily with meals, and thiazolidinediones and the newer DPP-4 inhibitors only require one dose per day.
You should also keep side effects in mind, and weigh their risks against their benefits. Some classes may pose an increased risk for heart failure, but others may produce smaller, more inconvenient side effects such as gas, diarrhea, or constipation. Also, talk with your doctor about if alcohol should not be consumed with your medications.
The bottom line
There are more options for treating type 2 diabetes than ever. These medications allow for more flexible treatment in response to blood sugar levels, and they also allow more time before you may require insulin therapy.