There are several ways to treat type 2 diabetes. Although people with type 1 diabetes have to be treated with insulin, this is not necessarily the case with type 2 diabetes. This is where the so called oral antidiabetic drugs come in – these are medicines in the form of tablets. One exception is the analogues of GLP-1, which are also injected.
Metformin is the most important drug in type 2 diabetes and has been in use for a long time. Metformin works by blocking the accumulation of glucose in the liver, which reduces the amount of endogenous sugar in the blood. It also improves the cells' sensitivity to insulin. In addition, the effects on the gut and brain are suspected, which can also reduce blood sugar. For overweight people with type 2 diabetes, it is considered the first drug of choice. Side effects can be gastrointestinal discomfort such as nausea and diarrhea.
Sulfonylureas increase insulin production in beta cells of the pancreas. They may be used in patients with type 2 diabetes when metformin therapy is insufficient to effectively lower blood sugar or when intolerances to metformin occur. The side effects may be hypoglycaemia, which is more common than with metformin, weight gain or allergic reactions.
Inhibitors of DPP-4 (gliptins)
DDP-4 inhibitors have an effect on the intestinal hormone GLP 1. This helps reduce blood sugar levels in a number of ways, for example through the release of insulin. Glipines inhibit the degradation of GLP 1 after meals, so the intestinal hormone may work longer, reports the diabetes advisor. They are used when metformin is not effective or is often given in combination with metformin. The side effects are low. DDP-4 inhibitors are among the newest drugs in type 2 diabetes.
GLP-1 analogues also act through the intestine. They mimic the effect of intestinal hormone GLP 1. As a result, the pancreas produces more insulin. They are used as a combination, even under insulin therapy. Because the drug is expensive, it is only paid if other therapies do not help. GLP-1 analogues should be injected.
inhibitors of SGLT-2
These drugs inhibit SGLT 2 protein in the kidneys. This usually prevents glucose from being excreted in the urine. By inhibiting SGLT 2, however, the body releases more sugar from the urine. As SGLT-2 inhibitors promote weight loss, they are suitable for overweight people and type 2 diabetes. They also lower blood pressure. Possible side effects are fungal infections, especially in the genital area.
Source: Findings of Diabetes 1/2019