Pharmacologic therapy of type 2 diabetes has changed dramatically in the last 10 years, with new drugs and drug classes becoming available
These drugs allow for the use of combination oral therapy, often with improvement in glycemic control that was previously beyond the reach of medical therapy.Agents used in diabetic therapy include the following
Biguanides
Metformin (Glucophage, Fortamet, Glumetzam, Riomet)
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Sulfonylureas
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Glyburide (DiaBeta, Glynase)
Glipizide (Glucotrol, Glucotrol XL, Glipizide XL)
Glimepiride (Amaryl)
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Meglitinide derivatives
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Repaglinide (Prandin)
Nateglinide (Starlix)
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Alpha-glucosidase inhibitors
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Acarbose (Precose)
Miglitol (Glyset)
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Thiazolidinediones (TZDs)
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Pioglitazone (Actos)
Rosiglitazone (Avandia)
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Glucagonlike peptide–۱ (GLP-1) agonists
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Exenatide (Byetta, Bydureon)
Liraglutide (Victoza)
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Dipeptidyl peptidase IV (DPP-4) Inhibitors
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Albiglutide (Tanzeum)
Dulaglutide (Trulicity)
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Sitagliptin (Januvia)
Saxagliptin (Onglyza)
Linagliptin (Tradjenta)
Alogliptin (Nesina)
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Selective sodium-glucose transporter-2 (SGLT-2) inhibitors
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Canagliflozin (Invokana)
Dapagliflozin (Farxiga)
Empagliflozin (Jardiance)
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Insulins
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Amylinomimetics
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Pramlintide (Symlin, SymlinPen 120, SymlinPen 60)
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Bile acid sequestrants
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Colesevelam (WelChol)
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Dopamine agonists
Traditionally, diet modification has been the cornerstone of diabetes management
Weight loss is more likely to control glycemia in patients with recent onset of the disease than in patients who are significantly insulinopenic. Medications that induce weight loss, such as orlistat, may be effective in highly selected patients but are not generally indicated in the treatment of the average patient with type 2 diabetes mellitus
Patients who are symptomatic at initial presentation with diabetes may require transient treatment with insulin to reduce glucose toxicity (which may reduce beta-cell insulin secretion and worsen insulin resistance) or an insulin secretagogue to rapidly relieve symptoms such as polyuria and polydipsia
