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Medications for Type 2 Diabetes

Robert J. Tanenberg, MD, FACP

Feb 1, 2005

Part 2: How to Tell Which One Is Right for You

Note: This is the second part of a two-part series. The first part was published in our January 2005 issue

Meglitinides and Phenylalanine Derivatives

The meglitinide class of drugs includes Prandin (repaglinide). The phenylalanine class includes Starlix (nateglinide).

These two drugs came onto the U.S. market in the mid 1990s and have found a niche in the treatment of certain people with type 2 diabetes.

As cousins to the sulfonylureas, these medications also require at least some pancreatic beta cell function to work. They stimulate insulin faster and for a shorter period of time than the sulfonylureas. Therefore, for maximum effectiveness and to minimize possible hypoglycemia, they must be taken with the first bite of every meal that contains carbohydrate.

The main benefits of these drugs is that they have less incidence of hypoglycemia and provide greater flexibility in terms of meals and exercise than the sulfonylureas. The drawbacks are that patients often forget to take them with the afternoon meal, and they are much more expensive and less potent than the sulfonylureas.

Biguanides

These drugs do not lower blood glucose; instead, they prevent it from rising overnight and before meals. Metformin, also marketed as Glucophage or Glucophage XR, is the only biguanide currently available in the United States. This drug reduces the amount of starch breakdown by the liver in the fasting state and for several hours after eating.

Metformin offers several unique and helpful features for patients:

It does not cause weight gain (weight neutral)
It may actually help with weight loss
It lowers cardiovascular risk
It restores ovulation in some women with polycystic ovary syndrome (an insulin-resistant condition)

The main side effects of metformin are nausea and diarrhea, which can be limited by taking it with or after meals and by starting with the lowest possible dose.

Patients with kidney or liver disease or who have a history of alcohol abuse or congestive heart failure should not take this medication.

Medications for Type 2 Diabetes

Jan 1, 2005

Categories: Blood Glucose, Diabetes, Diabetes, Insulin, Low Blood Sugar, Type 2 Issues, Type 2 Medications

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