Diet, exercise and weight loss are the foundation for the management of type 2 diabetes. However, in some instances, you may need medications on top of these healthy lifestyle choices to achieve good control of your diabetes. Sometimes a single medication is enough. Other times, a combination of medications may be needed.

There are many types of medications used in type 2 diabetes. While there is no “best” medication, some medicines may work better for you. The decision on which medications are best suited for you depends on many factors, including your lifestyle factors, underlying root causes of diabetes, your blood sugar level and any other health problems you have. Learning about these drugs — dosing frequency, mode of action, benefits and side effects — will help you discuss treatment options with your doctor.

Related article: Guide to Diabetes Treatments in Singapore

How diabetes medication lower blood sugar

There are several classes of medication for diabetes. Each class works in a different way to lower blood sugar. These are the common mechanisms by which they work:

• Stimulating the pancreas to produce and release more insulin

• Inhibiting the production and release of glucose from the liver

• Blocking the action of gastrointestinal 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 medication may contain several drugs. Depending on the type, medication for diabetes may be taken orally or by injection. Medication can be taken once a day or more frequently depending on the class, formulation and your condition. Many of the medications below now come in combinations, reducing the number of pills or injections you may have to take.

Oral medications used in type 2 diabetes

Medications that increase insulin secretion (secretagogues)

Sulfonylureas

These are among the oldest diabetes drugs still used today. Sulfonylureas function by stimulating the release of insulin from pancreatic beta cells. They may cause weight gain and increase the risk of hypoglycemia.

Meglitinides

Similar to sulfonylureas, meglitinides cause the pancreas to release more insulin. However, they are much shorter acting than sulfonylureas. 

Dipeptidyl-peptidase 4 (DPP-4) inhibitors

DPP-4 inhibitors are a class of drug which help to stimulate the production of insulin and reduce the production of glucagon, particularly during digestion, in a glucose-dependent manner. They work by blocking the action of the DPP-4 enzyme in the body.

Medications that increase insulin sensitivity 

Biguanides (Metformin)

Metformin decreases how much sugar your liver makes. They make your body more sensitive to insulin, and help your muscles absorb more glucose. They do not increase insulin levels or cause weight gain. Alone, they rarely cause hypoglycemia. Metformin is commonly used as a first-line treatment for type 2 diabetes.

Thiazolidinediones

Thiazolidinediones work by decreasing glucose in your liver. They also help your fat cells use insulin better. These drugs come with an increased risk of heart disease. If your doctor gives you one of these drugs, they’ll watch your heart function during treatment.

Others

Alpha-glucosidase inhibitors

Alpha-glucosidase inhibitors prolong the absorption of carbohydrates and thus help to prevent postprandial glucose surges. 

Sodium-glucose transporter 2 (SGLT2) inhibitors

SGLT-2 inhibitors are a relatively new class of glucose-lowering drugs that cause the kidneys to excrete excess glucose through the urine. They are a unique drug class in that they work independently of insulin. Some drugs within the class appear to decrease cardiovascular morbidity and mortality (amongst those with established cardiovascular disease), as well as reduce the progression of diabetes-associated kidney disease.

Glucagon-like Peptide-1 Agonists (GLP-1 receptor agonists)

These drugs are similar to the natural hormone called incretin. They stimulate glucose-dependent insulin release, decrease your appetite and glucagon secretion. They also slow stomach emptying. Semaglutide has been shown to significantly help with weight loss.

Injectables used in type 2 diabetes

Non-insulins

Glucagon-like Peptide-1 Agonists (GLP-1 receptor agonists)

These drugs are similar to the natural hormone called incretin. They stimulate glucose-dependent insulin release, decrease your appetite and glucagon secretion. They also slow stomach emptying. They have been shown to decrease cardiovascular morbidity and mortality in those with cardiovascular disease, and can help with weight loss.

Insulins

Insulin injections are used in treatment of both type 1 and type 2 diabetes. The injected insulin acts as a replacement for or supplements your body’s insulin. Close monitoring of sugar level is important when administering insulin therapy. Discuss how best to do this with your doctor.

Speak with your doctor

There are many medications available for the treatment of diabetes. They work in different ways to help you control your blood sugar and they each bring different benefits and disadvantages. Discuss with your doctor which medication or combination of medications will work best for you. You can make that decision based on your goals, health and other lifestyle factors.

For more information about NOVI Health’s services for diabetes, check out this page. Check out our other articles to learn more about nutrition and exercise in diabetes.