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Are there any prescription treatments for type 2 diabetes?

Doctors recommend prescription medicines when diet and exercise don't effectively lower blood sugar levels. Oral prescription medicines and insulin injections can control blood sugar. These five types of medicine are:

Sulfonylureas, the oldest class of oral medicines used to control blood sugar. There are seven different sulfonylurea drugs currently available: tolbutamide (brand name Orinase), chlorpropamide (Diabinese), tolazamide (>Tolinase), acetohexamide (Dymelor), glipizide (>Glucotrol), glyburide (>Diabeta, >Micronase), and glimeperide (>Amaryl). These medicines work by increasing the release of insulin from the pancreas. Doctors often prescribe a drug in this class first. They may recommend using it alone or in combination with other medicines when a better effect is needed. These are the least expensive oral diabetes medicines available.

Repaglinide (>Prandin), which works like the sulfonylureas, increasing the release of insulin from the pancreas. The difference is that repaglinide belongs to a class of medicines called meglitinides.

Metformin (>Glucophage), which belongs to a class of medicines called biguanides. It works to slow the release of glucose from the liver and increase sensitivity to insulin in the muscles. Metformin is a good choice for overweight people. Doctors use it alone or in combination with sulfonylureas or insulin for extra effect. Metformin has no effect on insulin production, so it doesn't cause low blood sugar (a dangerous condition also known as "hypoglycemia").

Lactic acidosis (high level of lactic acid in the blood) is a rare but serious side effect that may occur when taking metformin in people with other health issues (such as heart, kidney, lung, or liver disease). Notify a doctor if any of these symptoms occur: serious infection, severe diarrhea, vomiting, fever, or excessive thirst.

Thiazolidinediones rosiglitazone (>Avandia) and pioglitazone (>Actos), improve blood sugar control by making the body more sensitive to insulin. Doctors use these medicines alone or combined with other diabetes drugs.

Due to potential heart risks for some people taking Avandia and Actos, people should ask their doctor about the benefits and risks of these medications but should not stop taking any prescribed medications without first discussing the issue with their healthcare provider.

Acarbose (>Precose), and miglitol (Glyset), which can lower blood sugar levels after meals by blocking enzymes that break down carbohydrates. Acarbose has no effect on pre-meal blood sugar levels. It can be used alone or in combination with other drugs. If you have a problem with high blood sugar after meals, acarbose may be a good choice for you.

The following combination pills combine the action of two oral diabetes medications for people who require several medications for better blood sugar control: glipizide/metformin HCL (Metaglip), glyburide/metformin HCL (Glucovance), pioglitazone HCL/metformin HCL (Actoplus met), rosiglitazone maleate/glimepiride (Avandaryl), rosiglitazone maleate/metformin HCL (Avandamet), and sitagliptin/metformin HCl (Janumet).

Sources:
Pharmacotherapy: A Pathophysiologic Approach. Appleton & Lange, 1999.
Micromedex® Healthcare Series. Thomson Micromedex, 2007.
Drug Facts and Comparisons. Facts & Comparisons, 2007.
Type 2 diabetes. www.diabetes.org. American Diabetes Association. Last accessed 6/2007.

This answer prepared 11/2/2000.
This information updated 6/11/2007.

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