From the Guidelines
Medications for diabetes should prioritize metformin as the first-line treatment, with SGLT-2 inhibitors and GLP-1 receptor agonists considered for their additional benefits in reducing cardiovascular risk and improving renal outcomes, as supported by the most recent evidence from 2024 1.
Medication Classes
- Metformin: typically the first-line medication, reducing glucose production in the liver and improving insulin sensitivity
- SGLT-2 inhibitors (e.g., empagliflozin, dapagliflozin): help the kidneys remove glucose through urine, with benefits in reducing cardiovascular risk and improving renal outcomes
- GLP-1 receptor agonists (e.g., semaglutide, dulaglutide): slow digestion, increase insulin release, and reduce appetite, administered as weekly injections
- DPP-4 inhibitors (e.g., sitagliptin): prevent the breakdown of incretin hormones
- Sulfonylureas (e.g., glipizide, glimepiride): stimulate insulin release from the pancreas
- Insulin therapy: essential for type 1 diabetes, including rapid-acting, short-acting, intermediate-acting, and long-acting formulations
Key Considerations
- Proper medication selection depends on diabetes type, blood sugar levels, other health conditions, and lifestyle factors
- Regular blood glucose monitoring is crucial for medication effectiveness, and dosage adjustments should only be made under medical supervision
- The choice of medication should consider the patient's values and preferences, as well as the potential benefits and harms of each medication, as discussed in the 2024 systematic review and network meta-analysis 1
Recent Evidence
- The 2024 systematic review and network meta-analysis found that SGLT-2 inhibitors and GLP-1 receptor agonists reduce all-cause mortality and major adverse cardiovascular events (MACE) compared to usual care 1
- The same review found that SGLT-2 inhibitors reduce chronic kidney disease (CKD) progression and heart failure hospitalization, while GLP-1 receptor agonists reduce stroke compared to usual care 1
From the FDA Drug Label
The following medications are mentioned in the context of diabetes treatment:
- Insulin Glargine (SQ)
- NPH insulin
- Regular human insulin
- Insulin lispro
- Canagliflozin (PO)
- Metformin HCl
- Sulfonylurea
- Acarbose
- Sitagliptin
- Pioglitazone
- Glimepiride
The medications for diabetes mentioned in the drug labels are:
- Insulins: Insulin Glargine, NPH insulin, Regular human insulin, Insulin lispro
- Oral antidiabetic medications: Canagliflozin, Metformin HCl, Sulfonylurea, Acarbose, Sitagliptin, Pioglitazone, Glimepiride 2, 3
From the Research
Medications for Diabetes
The following medications are used to treat diabetes:
- Metformin: a first-line oral therapy for type 2 diabetes mellitus (T2DM) 4, 5
- Sodium-glucose cotransporter 2 (SGLT2) inhibitors: such as dapagliflozin, which reduces hyperglycemia by increasing urinary glucose excretion independent of insulin 6
- Incretin-based therapies: used for the management of individuals with T2DM 4
- Sulfonylureas: such as glimepiride, glipizide, and glyburide, which stimulate insulin release from the pancreas 7, 6, 8
Comparison of Medications
Studies have compared the efficacy and safety of different medications for diabetes:
- Dapagliflozin versus glipizide: dapagliflozin produced significant adjusted mean weight loss and decreased the proportion experiencing hypoglycemia compared to glipizide 6
- Metformin versus sulfonylureas: metformin is associated with a lower risk of overall mortality compared to glipizide, glyburide, and glimepiride 8
- Glimepiride: has been shown to be safe and effective in reducing fasting and postprandial glucose levels, as well as glycosylated hemoglobin concentrations 7