Successful treatment for people with diabetes often depends on a combination of healthy lifestyle habits balanced with an individualized medication regimen. There are a variety of medications approved for the treatment of diabetes. The provider team at Draelos Metabolic Center partners with each person individually to choose medications that their lifestyle, financial and health needs best.
|Metformin||SGLT-2 Inhibitors||GLP-1 Receptor Agonists||DPP-4 Inhibitors|
Metformin is considered the first-line drug for treating type 2 diabetes. It can also be used to stop the progression toward diabetes in those who are insulin resistant but have yet to be diagnosed. Metformin works in two ways. First, it limits the release of glucose from the liver. Second, it reduces insulin resistance so the body can use insulin efficiently. Metformin can be combined with other blood glucose lowering medications. Common side effects include nausea, diarrhea, gas, and abdominal pain. Metformin should also be used with caution in patients with poor kidney function.
This is the newest class of medications on the market to treat diabetes. The first one was FDA approved in March of 2013. They work by inhibiting glucose re-absorption in the kidneys. Essentially, blood glucose levels are lowered by eliminating sugar through the urine. This drug has also been shown to lower blood pressure and promote weight loss. Common side effects are vaginal yeast infections and urinary tract infections. The brand names for this drug are Invokana and Farxiga.
These are injectable medications that mimic the hormone glucagon-like peptide 1 (GLP-1), which tells the pancreas to produce more insulin following a meal. Like Metformin, they also decrease the amount of glucose released from the liver. A positive side effect of GLP-1 receptor agonists is that they often lead to an increased feeling of fullness which leads to weight loss. Common side effects are nausea and vomiting but these often resolve over time.
There are three available forms of this medication: Byetta (twice daily), Victoza (once daily) and Bydureon ER (once weekly).
DPP-4 Inhibitors are oral medications that use a similar mechanism to GLP-1 receptor agonists. They prevent the breakdown of the body's naturally occurring GLP-1, which allows it to stay active in the body longer. They have few side effects and will not cause weight gain. This class of medications includes Januvia, Onglyza, and Tradjenta.
These medications help to lower blood sugar by stimulating the pancreas to produce more insulin. Common side effects include hypoglycemia and weight gain. The three most commonly used sulfonylureas are glimepiride, glipizide, and glyburide.
TZDs are oral medications that help lower HbA1c 1% to 2% by decreasing insulin resistance. While they are very effective at lowering blood sugar, they are highly associated with weight gain and fluid retention. Actos is the only readily available TZD.
Bromocriptine was first approved for neurological conditions like Parkinson disease. It was found to also lower blood glucose levels. The exact mechanism is unknown but it is believed that the drug helps regulate the body's normal cycle of hormones, including insulin. Bromocriptine may lead to low blood pressure, fainting, nausea, vomiting, diarrhea, and constipation. The brand name for it is Cycloset.
Although it was first approved to help lower cholesterol, colesevelam has recently been approved to help lower blood glucose as well. It works directly in the digestive tract to reduce the absorption of carbohydrate. Side effects include constipation, indigestion, and nausea. It may also raise triglycerides in some patients and can interact with other medications. The brand name for colesevelam is Welchol.
Meglitinides are medications that, much like sulfonylureas, increase insulin production in the pancreas. However, they are short acting and must be taken with each meal. Common side effects are hypoglycemia and weight gain. Brand names are Starlix and Prandin. Starlix is available as a generic.
Pramlinitide is a synthetic form of amylin, a hormone that is naturally released from the pancreas along with insulin. It is an injectable medication that works with insulin to prevent spikes in blood sugar after a meal, resulting in better glucose control and a lower A1c in people who take insulin. Other benefits may include decreased insulin need and weigh loss. Drawbacks include three additional injections each day and risk of severe hypoglycemia. The brand name for pramlinitided is Symlin.
This class of medication works by delaying the breakdown and absorption of carbohydrates in the digestive tract and should be taken with the first bite of a meal. Because they work in the digestive tract, this medication commonly causes abdominal pain, bloating, gas, and diarrhea. Brand names of this medication are Precose and Glyset.
Injectable forms of insulin are required when there is an absence of insulin production by the body or the body cannot produce enough insulin to overcome insulin resistance. Insulin is available in long acting, intermediate acting, short acting and rapid acting forms. The type and amount of insulin is individualized for each person.