Diabetes Type 2

Controlling diabetes with metformin and other 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 there are many more types of medication for type 2 diabetes discussed below.

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 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 has been linked to an increased risk of heart attack and stroke.

Since these interviews were conducted in 2008, there has been growing concern about the potential harmful effects of rosiglitazone (Avandia, but also contained in Avandamet and Avaglim) and from September 2010 in the UK and Europe, new prescribing of this drug has stopped, and most people who were taking the drug have been changed to alternative medication. 

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')

Other types of medication used for type 2 diabetes are:

  • Sulphonylureas (such as glibenclamide, gliclazide, glimepiride, glipizide and gliquidone) - which increase the amount of insulin that's produced by your pancreas. 
  • Glitazones - thiazolidinediones (such as pioglitazone) – which make your body’s cells more sensitive to insulin so that more glucose is taken from your blood.
  • Gliptins - DPP-4 inhibitors (such as linagliptin, saxagliptin, sitagliptin and vildagliptin) – which prevent the breakdown of GLP-1 a naturally occurring hormone. GLP-1 helps the body produce insulin in response to high blood glucose levels, but it is normally rapidly broken down.
  • GLP-1 agonists (such as exenatide and liraglutide) an injectable treatment that acts in a similar way to the natural hormone GLP-1. Their great advantage over insulin is that they rarely lead to "hypos". Exenatide is normally given twice a day but a once weekly product has been introduced. Liraglutide is given once a day.
  • Alpha  Glucosidase Inhibitor (such as acarbose)- which slows down the rate at which your digestive system breaks carbohydrates down into glucose and helps prevent your blood glucose level from increasing too much after a meal.
  • Prandial Glucose Regulator (such as nateglinide and repaglinide) which stimulate the release of insulin by your pancreas.
  • SGLT2 Inhibitors (such as dapagliflozin, canagliflozin and empagliflozin) – which reduce the amount of glucose being absorbed in the kidneys so that it is passed out in the urine. Lowering the amount of glucose in your blood.

We have yet to interview anyone who has been prescribed these medications. If you have had this medication and you would like us to include your story on this website, please email info@healthtalk.org.  info@healthtalk.org
 

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 March 2016.

Last updated March 2016.

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