Type 2 diabetes happens when the body cannot use the hormone insulin properly, so sugar builds up in the blood. Changing your lifestyle—eating healthier and moving more—is usually the first step to managing diabetes. But many people also need medication to keep their blood sugar at a safe level.
Over the past 20 years, doctors and scientists have tested many medicines. As a result, there are now more treatment options than ever, and they are safer too. Here is what you should know about the most commonly used diabetes medicines today.
The most common and oldest drug is called metformin. It works by helping the liver make less sugar and by helping the body respond better to insulin.
Big studies, like one from the UK, show that metformin not only lowers blood sugar but also reduces the risk of heart attacks and helps with a little weight loss. It is usually the first drug doctors give because it is cheap, safe, and works well. Some people get mild stomach problems, but this often goes away after a few weeks.
If metformin is not enough, doctors may add another medicine like SGLT2 inhibitors. Examples include empagliflozin and dapagliflozin. These drugs help the kidneys remove sugar from the body through urine.
Studies show that they not only lower blood sugar but also protect the heart and kidneys. In people with both diabetes and heart disease, these medicines reduce the risk of going to the hospital for heart failure by about 30%. They can cause more urination and sometimes yeast infections, but most people do fine on them.
Another newer group of drugs is GLP-1 receptor agonists. These include medicines like semaglutide and liraglutide. They act like a natural hormone that helps the body release insulin after eating. They also slow down digestion, reduce hunger, and can help people lose a lot of weight.
In one big study, people taking semaglutide lost about 15% of their body weight and improved their blood sugar levels so much that some no longer needed other treatment.
These drugs also help prevent heart attacks and strokes in people with diabetes and heart disease. The main downside is nausea in the first few weeks and the cost, although many countries help pay for them because of the heart benefits.
There is also a group called DPP-4 inhibitors, like sitagliptin. These help the body keep its own GLP-1 active longer. They are gentle, don’t cause weight gain or low blood sugar, but their effects are weaker.
They are good for people who only need a small improvement. They are also safe for the heart and kidneys, but they don’t give the strong heart protection that SGLT2 and GLP-1 drugs do.
Older medicines like sulfonylureas (such as gliclazide) and thiazolidinediones (like pioglitazone) are still used. Sulfonylureas help the body make more insulin fast, but they can cause low blood sugar and weight gain.
Thiazolidinediones help the body use insulin better but may cause swollen ankles or weaker bones. These are cheaper and may be used when newer drugs aren’t an option.
Some people may need insulin, especially if their pancreas is very weak. Basal insulin is taken once a day to keep blood sugar steady between meals and at night. It works very well but needs careful dose changes to avoid low sugar levels. Many people use insulin together with other drugs like metformin or SGLT2 and GLP-1 drugs.
There is no single “best” medicine for everyone. Doctors choose based on your sugar levels, weight, heart and kidney health, cost, and personal preferences. Often, using two or more drugs that work in different ways gives better results than increasing the dose of just one.
What matters most is keeping your blood sugar in the target range, seeing your doctor regularly, and changing the plan when needed. With today’s treatments, most people with type 2 diabetes can find a mix of medicines that works well for them.
If you care about diabetes, please read studies about Vitamin D and type 2 diabetes, and to people with diabetes, some fruits are better than others.
For more health information, please see recent studies that low calorie diets may help reverse diabetes, and 5 vitamins that may prevent complication in diabetes.
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