Why Today’s Oral Agents Are Better Than Ever

In the years prior to 1995, there was only onetype of oral medication to treat type 2 diabetes.Today, diabetes practitioners can choose frommany classes of oral agents. Each group may beused alone or in combination, depending on theindividual and his or her history, disease stage,complications, side effects of the drugs andfinances.


The sulfonylureas are the oldest class of oralmedications. These drugs function by stimulatingthe release of insulin from the remainingpancreatic beta cells. The newer sulfonylureassuch as Glucotrol (glipizide) and Amaryl(glimipiride) are safer and have fewer side effectsthan the older drugs. The most common sideeffect of all sulfonylureas is hypoglycemia. Thesedrugs are most effective in people who are at theirnormal weight or slightly overweight.

Meglitinides and phenylalanine derivatives

Prandin (repaglinide), a drug of the meglitinideclass, and the phenylalanine derivative Starlix(nateglinide) work by causing a short burst ofinsulin to be released from the pancreas, whichprevents the rise in glucose after meals. Theyhave only a minimum effect on fasting glucoselevels. They are especially useful for people whoeat at irregular times or eat variable amountsof food. These drugs must be taken just beforethe meal, and the dose is skipped if the meal isskipped. They have a fast onset and a shorteraction time than the sulfonylureas. This groupis less likely to cause hypoglycemia than thesulfonylureas.

Alpha-glucosidase inhibitors

Precose (acarbose) and Glyset (miglitol) preventa rise in glucose levels after meals but act byslowing the absorption of carbohydrates.


Metformin, the only available drug in thisgroup, is the most widely prescribed diabetesmedication in the United States. It works byreducing glucose output from the liver andrequires the presence of insulin. The drug workswell in normal and overweight patients with type2 diabetes. However, those with poor kidneyfunction or active liver disease should not takemetformin. Side effects include nausea, soft bowelmovements and mild appetite loss. This drug doesnot cause weight gain.


Actos (pioglitazone) and Avandia (rosiglitazone)work by increasing muscle and liver use of insulinand decreasing glucose production. Insulin mustbe present for these drugs to work. These are excellentagents for people who are insulin resistant. They areeasily combined with other oral agents and insulin.This group of agents improves lipid levels, may reducecardiovascular events and shows promise of preventingtype 2 diabetes by preserving beta cells. Side effectsinclude weight gain, edema and heart failure.

Not Your Grandmother’s Type 2 Meds

In addition to these individual pills, there are also severalnewer oral agents on the market, which combine drugsfrom two different classes. And new injectable type 2drugs such as Symlin and Byetta are now available aswell.

The good news is, you are no longer taking the lastgeneration’s diabetes meds. The new diabetes pillsshould help you achieve better glucose control to preventdiabetes complications. These drugs may even helpprolong the “life” of your remaining beta cells.

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