Being diagnosed with diabetes has a big impact on your life. Although some people can successfully manage their diabetes through weight management, exercise, and diet alone, many people will also need some form of medication.
The type of medication your doctor prescribes will depend on factors such as your blood sugar levels and other health conditions.
The most common diabetes medicines are divided into groups according to their site of action and their effect.
| Improve insulin sensitivity | Increase insulin secretion |
| Metformin/ Biguanides | Sulfonylureas |
| Glucophage, Glucomin, Metformin | Amaryl, Glymipride, Gluben, Daonil, Glucorite |
| TZD’s (Thiazolidinediones) | Meglitinides |
| Actos, Pioglitazone | Novonorm, Repaglinide |
Tracking the breakdown and absorption of carbohydrates in the digestive tract
Alpha-Glucosidase Inhibitors
Prandase, Acarbose
Increase the excretion of glucose from the urine
SGLT-2 Inhibitors
Forxiga, Jardiance
Incretins-based drugs
DPP-4 Inhibitors
Januvia, Galvus, Onglyza, Trajenta
GLP1 RA (Glucagon-Like Peptide-1 Receptor Agonists.)
Victoza (liraglutide), Bydureon (exenatide), Lyxumia (lixisenitide), Trulicity (dulaglutide), Ozempic(semaglutide)
Basal Insulin
Levemir, Lantus, Basaglar, Tregludec, Toujeo
The ADA recommends that diabetes medicine treatment is customized according to the following:
1. Efficiency in lowering HbA1c percentage
The table below shows the percentage of HbA1c reduction according to each type of intervention. Note that the effect of lifestyle is equal to medication. This is the reason that lifestyle modifications including diet and exercise are always a part of diabetes treatment.
EXPECTED HbA1c REDUCTION ACCORDING TO INTERVENTION
| 1-2% | style=”border:1px solid;”Lifestyle |
| 1-2% | Metformin |
| 1.5-3% | Insulin |
| 1-2% | Sulfonylurea |
| 0.7-1.5% | TZDs |
| 0.7-1.5% | GLP-1 Agonist |
| 0.5-1% | SGLT-2 Inhibitor |
2. Reducing the risk of ischemic heart disease, heart failure, and kidney failure
Diabetes significantly increases the risk of cardiovascular (CVD) and kidney disease.
The updated guidelines for treatment are not only to lower glucose and AIc, but also to treat the heart and kidneys in relation to each other.
Drugs from the SGLT2 and GLP1 RA family clearly demonstrate heart and kidney protection that results in a lowering of the progression of damage and a reduction in associated death from damage to either of these organs.
3. Side effects profile: hypoglycemia and weight gain/loss
Hypoglycemia (low blood sugar)
Sulfonylureas work by stimulating the pancreas to produce more insulin. Because of the direct effect on insulin-secreting cells, the possibility of hypoglycemia is highly likely for someone treated with this family of medicines.
Meglitinides work in a similar way to sulfonylureas. These medicines are generally dosed before meals. They also have a risk of causing hypoglycemia and weight gain.
Basal or short-term insulin therapy has the potential to cause low sugar events due to improper dose adjustment or poor injection technique.
Weight gain
Increased insulin secretion from taking Sulfonylureas or insulin injections may result in increased appetite resulting in increased eating, and potential weight gain.
TZD’s (Thiazolidinediones) help insulin work better in the muscle and fat and reduce glucose production in the liver. This may cause weight gain, anemia, and an increased risk of heart failure.
Weight loss
GLP1 RA medicines break the cycle by influencing the satiety mechanism (a mechanism that makes you feel full and satisfied during a meal), reducing appetite and potentially producing weight loss. The group has demonstrated cardiovascular and renal protection.
SGLT2 medicines protect the heart and kidneys and may cause weight loss due to calorie loss through the urinary system.
4. Oral or injectable?
The drug groups are divided into oral and injectable therapies.
Oral therapy: Metformin/biguanides, TZD’s (Thiazolidinediones), Sulfonylureas, Meglitinides, SGLT-2 and Inhibitors DPP-4 Inhibitors.
Injectable therapy: Basal/short Insulin and GLP1 RA.
It is important that you understand the reasons and the actions for the medicines your physician prescribes. Follow the recommendations and report to the medical staff if you have any unwanted side-effects or are unsure how to take your medication.
1. Diabetes Care, American Diabetes Association, 2020
2. Mearns ES et al. A Network Meta-Analysis. PLOS one 2015
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