Between ninety and ninety-five percent of individuals diagnosed with diabetes in the United States have type 2 diabetes. Many individuals diagnosed with type 2 diabetes are able to manage their condition through lifestyle changes, such as getting regular exercise and eating a well-balanced diet. When diet and exercise changes alone do not lower blood glucose levels adequately, medication and/or insulin therapy may be necessary. The medication prescribed depends on various factors relating to the individual and his or her specific diagnosis. Each type of medication lowers blood glucose levels using a different mechanism. The types of medications used to treat type 2 diabetes, as well as how they work, are described below.
Insulin therapy
Insulin therapy involves injecting external sources of insulin. When insulin is injected into the body, it acts as a replacement for the insulin that the body cannot produce. It then works to move glucose out of the bloodstream and into the tissues, where it is stored for energy. Insulin therapy can be administered by either multiple daily needle injections or through the use of an insulin pump.
Individuals diagnosed with type 2 diabetes often need increasing amounts of insulin as time goes on. For individuals who need more than 100 units of insulin a day, a large capacity insulin pump with a touchscreen can be a convenient way of getting the amount of insulin needed.
GLP-1 Analogs and Agonists
This group of medications mimic the actions of a glucagon-like peptide that lowers glucagon and glucose levels in the body. In addition, these medications can increase insulin secretion from the pancreas, help reduce appetite, and increase beta cell mass to speed up insulin delivery into the liver and bloodstream. GLP-1 analogs and agonists can help slow the loss of insulin production and help control post-meal glucose levels.
Alpha-Glucosidase Inhibitors
Alpha-glucosidase inhibitors are medications that block the body’s ability to break down foods that have large amount of starches, such as pasta, potatoes, and bread, and therefore slow the rise in blood glucose levels after eating these foods. Starchy foods tend to significantly raise blood glucose levels because the body quickly turns the starch into sugar.
Biguanides
Biguanides are medications that act to reduce the amount of glucose produced by the liver, leading to a resulting decrease in the amount of glucose in the bloodstream.
Bile Acid Sequestrants
Bile acid sequestrants are medications used to lower cholesterol, more specifically low-density lipoprotein (LDL, or “bad”) cholesterol. As a result, blood glucose levels are also reduced. The mechanism by which bile acid sequestrants lower glucose levels in the bloodstream is not fully understood, but is currently being studied by scientists.
DPP-4 Inhibitors
DPP-4 inhibitors are medications that aim to reduce A1C numbers (the number that represents the average amount of blood glucose within a three month period) by working with certain naturally occurring substances in the body. More specifically, DPP-4 inhibitors block the breakdown of a GLP-1 hormone which naturally lowers blood glucose levels, so it can be active in the body longer.
Meglitinides & Sulfonylureas
Meglitinides and sulfonylureas are medications that stimulate the release of insulin from the pancreas. These medications work by activating the beta cells located in the pancreas, which are characteristically damaged in the case of type 2 diabetes. The main function of beta cells is to regulate the storage and the release of insulin.
SGLT2 Inhibitors
SGLT2 inhibitors are medications that work by removing excess glucose from the bloodstream and disposing of it through the urine.
Have Questions About Medications Used to Treat Type 2 Diabetes?
If you have been diagnosed with type 2 diabetes and you have questions regarding medications, talk to your doctor. Your diabetes care team will help you understand whether you need medication to manage your specific diagnosis and, if so, which medication is best for you.
Sources:
https://www.mayoclinic.org/diseases-conditions/type-2-diabetes/diagnosis-treatment/drc-20351199
https://www.healthline.com/health/diabetes/medications-list#takeaway
https://www.niddk.nih.gov/health-information/diabetes/overview/insulin-medicines-treatments
https://www.niddk.nih.gov/health-information/diabetes/overview/tests-diagnosis/a1c-test
http://diabetes.diabetesjournals.org/content/51/suppl_3/S434
https://www.cdc.gov/diabetes/basics/type2.html
https://www.diabetesnet.com/about-diabetes/diabetes-medications/incretins/glp-1-agonist
