medications for managing type 2 diabetes

6 Main Categories of Oral Medications:

All six of these classes of drugs manage type 2 diabetes: sulfonylureas, biguanides, thiazolidinediones, alpha-glucosidase inhibitors, meglitinides and DPP-4 inhibitors. They may work in different ways to help diabetes patients but they all help to maintain good blood glucose control.

Sulfonylureas:

These medications are the oldest of the oral meds. Tolinase (tolazamide) has been around since the 1950's. It's still prescribed today. Newer drugs in this class include Glucotrol (glipizide), Glucotrol XL (glipizide extended release), Amaryl (glimepiride), Diabeta (glyburide), and Micronase (glyburide). They're hypoglycemic agents because they allow the pancreas to release more insulin into the blood which lowers the glucose level. Hypoglycemia is a common side effect. Many of these drugs are only effective for a few years and then may stop working.

Biguanides:

These drugs work by affecting the production of glucose that comes from digestion. They don't cause hypoglycemia and even help with weight loss and lower cholesterol numbers. They are the most commonly prescribed drugs for type 2 diabetes. Glucophage (metformin) and Glucophage XR (metformin extended release) are the most well known of these drugs.

Alpha-Glucosidase Inhibitors:

Glyset (miglitol) and Precose (acarbose) are the two most prescribed alpha-glucosidase inhibitors (aka "starch blockers") They work differently than the other medications reviewed so far. These medications need to be taken at the beginning of each meal so that they can work to slow digestion, which in turn slows the rise of glucose in the blood. They are often prescribed in conjunction with other diabetes medications. These drugs may cause diarrhea or gas.

Thiazolidinediones :

These drugs work by sensitizing muscle and fat cells to accept insulin more readily. Actos (pioglitazone) and Avandia (rosiglitazone) are the only two thiazolidinediones marketed today.
 As of May 21, 2007, the Food and Drug Administration has issued a safety alert regarding the possibility of heart attacks or other fatal cardiovascular events when taking Avandia. Please call your physician to discuss alternative medications for managing your diabetes.

• Avandia May Cause Risk of Heart Attack and Death
• Avandia Linked to Increased Heart Attacks

Meglitinides:

This class of drugs is similar to the alpha-glucosidase inhibitors in that they are taken before each meal. But these drugs stimulate the pancreas to produce more insulin in relationship to how much glucose is in the blood. The brand names for these drugs are Prandin (repaglinide) and Starlix (nateglinide). They can be used in combination with some other oral medications for increased effectiveness.

DPP-4 Inhibitors:

A new oral medication called Januvia (sitagliptin phosphate) has been approved by the FDA for management of type 2 diabetes. It's the first in a new class of drugs called DPP-4 inhibitors. Januvia lowers blood sugar levels by blocking an enzyme known as dipeptidyl peptidase IV or DPP-4.
Januvia showed good results in recent trials both in combination with other drugs, like metformin, and also by itself. It is prescribed for type 2 diabetes only. It does not need to be taken with a meal, as some other classes of oral diabetes medications do.