Diabetes Type 2

Controlling diabetes with oral medications

Many people with type 2 diabetes are prescribed tablets to help control their blood glucose levels. Metformin is the first-line medication for diabetes in the UK, but we also talked to people who were taking gliclazide and rosiglitazone. Preventive medication such as statins, are also prescribed routinely to people with diabetes to reduce the risk of heart disease/complications. 

Most people had tried initially to control their blood glucose with a regimen of diet and exercise before being given oral medication. Many people took metformin alone to control blood glucose, and some were taking metformin and gliclazide. Both medications help to reduce blood glucose but work differently. Metformin reduces the amount of glucose produced in the liver, and also makes muscle tissue absorb more glucose; gliclazide increases the amount of insulin produced by the pancreas. 

While everyone people found that the medication they took had helped reduce and control their blood glucose, many had experienced side effects. Metformin can cause diarrhoea and other digestive problems and many people went back to their GPs for advice. 

Some people felt concerned about the risks they might face from certain drugs after reading negative reports in the media (see 'Misunderstandings about diabetes'). Rosiglitazone (trade name Avandia) should not be prescribed for those known to be at risk of heart disease, and several people said they had decided not to take it. However rosiglitazone did suit some people. 

Most people we interviewed had been prescribed higher dosages of medication to control their blood glucose as their diabetes got worse over time. Some people had transferred to insulin while continuing on metformin (see 'Coping with Insulin').

Since these interviews were conducted in 2008, there has been growing concern about the potential harmful effects of rosiglitazone (Avandia, also contained in Avandamet) and from September 2010 in the UK and Europe, new prescribing of this drug has ceased, and most people who were taking the drug have been changed to alternative medication. A related drug, pioglitazone (Actos) has a similar mode of action but probably less risk of long-term harm.
Several other kinds of drug have been shown to reduce blood sugar in type 2 diabetes, though this is not the only or even the most important goal in managing the condition (see below):
  • Acarbose (Glucobay) works by impairing the uptake of sugars from food, but often causes feelings of bloating and abdominal discomfort.
  • Nateglinide (Starlix) and repaglinide (Prandin) can be used to reduce the rise in blood sugar level that often follows a meal, but the long-term benefit of this is uncertain.
  • Three new oral drugs ("gliptins") reduce blood sugar by blocking a hormone called DPP-4. These are sitagliptin (Januvia), saxagliptin (Onglyza) and vildagliptin (Galvus). Their long-term benefits are not known.
  • Two new injectable drugs are increasingly used to treat type 2 diabetes, especially in overweight patients because they often lead to weight loss. They work by imitating one of the body's own hormone classes (the incretins) which regulates sugar metabolism and appetite. They are usually used in combination with metformin. Exenatide (Byetta) is given by self-injection twice a day, and Liraglutide (Victoza) by self-injection once a day. Long-acting (once-weekly) preparations of these "incretin mimetics" are being developed. They have useful short-term benefits, though their long-term effects are not known. Their great advantage over insulin is that they rarely lead to "hypos" - drops in blood sugar that can impair consciousness. 

Preventive medications
People with type 2 diabetes have an increased risk of developing heart disease, a stroke and kidney disease and so may be advised to take other medicines to reduce the risk such as:

  • medicine to control blood pressure (e.g. beta blockers, diuretics, ACE inhibitors)
  • a statin, to reduce high cholesterol levels
  • an ACE inhibitor, if you have the early signs of diabetic kidney disease.

Many people we interviewed were also prescribed a statin preventively to reduce their blood cholesterol. Several people found this confusing, though it is standard practice for doctors to prescribe statins to people with type 2 diabetes even if their cholesterol levels are within the healthy range. 

Some people thought that that taking preventive medication such as statins might raise their insurance premiums. 

Many people with type 2 diabetes also take a low-dose aspirin tablet (75mg) daily but recent studies have not shown that this produces the previously expected level of protection against strokes and heart attacks.

Last reviewed November 2012.

Last updated November 2010.


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