The table below summarizes important information about the most commonly prescribed drugs for Type 2 Diabetes. Links to detailed discussions of these drugs and the research supporting the statements below can be found by scrolling to the bottom of this page.
| Diabetes Drug Summary |
| Drug | Mechanism | Benefits | Side Effects | Rating |
|---|
| Glucophage, Glucophage XR (Metformin, Metformin ER) | Keeps liver from dumping glucose. Makes muscles take up glucose. | Reduces insulin resistance and lowers triglycerides. May have anti-cancer effects. | Gas, abdominal pain, diarrhea. May cause Vitamin-B12 deficiency with long use. Fewer side effects with ER/XR extended release form. | +++++ |
| Avandia, (rosiglitazone) Avandamet (Avandamet is Avandia combined with metformin) | Affects PPAR-gamma receptor Grows new fat cells that take up glucose. | Reduces insulin resistance. | 66% more heart attacks. Causes water retention. Causes weight gain. Causes heart failure. Causes osteoporosis. Causes macular edema | ----- |
| Actos (pioglitazone) | Same as Avandia | Reduces insulin resistance | From Prescribing Information: "In postmarketing experience with ACTOS, cases of congestive heart failure have been reported in patients both with and without previously known heart disease....In postmarketing experience with ACTOS, reports of hepatitis and of hepatic enzyme elevations to 3 or more times the upper limit of normal have been received. Very rarely, these reports have involved hepatic failure with and without fatal outcome"Macular edema. Weight gain. Ovulation in premenopausal women. Raises LDL. | ----- |
| Precose (acarbose) | Blocks alpha glucosidase enzyme used to break down starches and complex sugars | Slows the digestion of carbs so that second phase insulin can deal with them | Gas | +++ |
Amaryl (glimepiride)
Diamicron (gliclazide)--not sold in U.S. | Newest Sulfonylurea. Stimulates beta cell to secrete insulin for 8 - 12 hours whether or not glucose is present in bloodstream | Raises insulin level | Can cause hypos. Causes hunger and weight gain May cause reversible beta cell burnout with prolonged use. Least heart attack risk of this class of drugs. | - |
Glyburide (Glucovance is glyburide with added metformin)
Glucatrol, Diabeta (glipizide) | Older Sulfonylurea. Stimulates beta cell to secrete insulin for 8 - 12 hours whether or not glucose is present in bloodstream | Raises insulin level | Stimulate receptors on heart tissue leading to higher rate of heart attacks | --- |
| Starlix (natalinide) | Meglitinide. Stimulates beta cell to secrete insulin for 1-3 hours whether or not glucose is present in bloodstream | Raises insulin level for a short time. Inhibits DPP-4 briefly | Can cause hypos. Causes weight gain, upper respiratory infection, back pain, flu symptoms, dizziness, joint problems. | - |
| Prandin (repaglinide) | Meglitinide. Stimulates beta cell to secrete insulin for 1-3 hours whether or not glucose is present in bloodstream | Stimulates insulin secretionl for 1-3 hours | Can cause hypos. Causes weight gain. Changes concentration of many other drugs including birth control pills in the bloodstream. May cause heart attacks. Upper respiratory infection, back pain, flu symptoms, dizziness, joint problems. Much worse safety profile than Starlix for similar effect. | -- |
| Byetta (exenatide) | Synthetic GLP-1 | Slows stomach emptying, which can lead to weight loss. Stimulates insulin secretion in intact beta cells. Very effective for 1/3 of those who take it, occasionally producing dramatic weight loss. | Vomiting. Nausea. Chills. Headache. Weakness. Blood pressure fluctuations. Tooth pain. Constipation. Nasal congestion. Very rarely, is associated with pancreatitis. | ++ |
Januvia (sitagliptin)
Janumet is Januvia combined with metformin | Inhibits the DPP-4 protease allowing GLP-1 and GIP levels to rise and stimulate insulin secretion and decrease glucagon production. DPP-4 is also a tumor suppressor gene, so inhibition of DPP-4 may promote cancers. | Stimulates insulin secretion in intact beta cells. | Cold symptoms, inflamed sinuses, raised blood pressure,constipation. Elevated leucocyte count. DPP-4 inhibition has been called "trigger for prostate cancer", also associated with metastasis in ovarian and lung cancers and melanoma. | -- |
| Onglyza (vildagliptin) | Inhibits the DPP-4 protease allowing GLP-1 and GIP levels to rise and stimulate insulin secretion and decrease glucagon production. DPP-4 is also a tumor suppressor gene, so inhibition of DPP-4 may promote cancers.. | Stimulates insulin secretion in intact beta cells. | Cold symptoms, inflamed sinuses, raised blood pressure,constipation. Lowers lymphocytes, sometimes dangerously. Concentration rises with grapefruit juice, ketoconazole, erythromycin, and verapamil. Raises peak concentrations of sulfonylureas, Actos and Avandia. DPP-4 inhibition has been called "trigger for prostate cancer", also associated with metastasis in ovarian and lung cancers and melanoma. | -- |
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