Why Today’s Oral Agents Are Better Than Ever

Today, diabetes practitioners can choose from many classes of oral agents

| Aug 1, 2005

In the years prior to 1995, there was only one type of oral medication to treat type 2 diabetes. Today, diabetes practitioners can choose from many classes of oral agents. Each group may be used alone or in combination, depending on the individual and his or her history, disease stage, complications, side effects of the drugs and finances.


The sulfonylureas are the oldest class of oral medications. These drugs function by stimulating the release of insulin from the remaining pancreatic beta cells. The newer sulfonylureas such as Glucotrol (glipizide) and Amaryl (glimipiride) are safer and have fewer side effects than the older drugs. The most common side effect of all sulfonylureas is hypoglycemia. These drugs are most effective in people who are at their normal weight or slightly overweight.

Meglitinides and phenylalanine derivatives

Prandin (repaglinide), a drug of the meglitinide class, and the phenylalanine derivative Starlix (nateglinide) work by causing a short burst of insulin to be released from the pancreas, which prevents the rise in glucose after meals. They have only a minimum effect on fasting glucose levels. They are especially useful for people who eat at irregular times or eat variable amounts of food. These drugs must be taken just before the meal, and the dose is skipped if the meal is skipped. They have a fast onset and a shorter action time than the sulfonylureas. This group is less likely to cause hypoglycemia than the sulfonylureas.

Alpha-glucosidase inhibitors

Precose (acarbose) and Glyset (miglitol) prevent a rise in glucose levels after meals but act by slowing the absorption of carbohydrates.


Metformin, the only available drug in this group, is the most widely prescribed diabetes medication in the United States. It works by reducing glucose output from the liver and requires the presence of insulin. The drug works well in normal and overweight patients with type 2 diabetes. However, those with poor kidney function or active liver disease should not take metformin. Side effects include nausea, soft bowel movements and mild appetite loss. This drug does not cause weight gain.


Actos (pioglitazone) and Avandia (rosiglitazone) work by increasing muscle and liver use of insulin and decreasing glucose production. Insulin must be present for these drugs to work. These are excellent agents for people who are insulin resistant. They are easily combined with other oral agents and insulin. This group of agents improves lipid levels, may reduce cardiovascular events and shows promise of preventing type 2 diabetes by preserving beta cells. Side effects include weight gain, edema and heart failure.

Not Your Grandmother’s Type 2 Meds

In addition to these individual pills, there are also several newer oral agents on the market, which combine drugs from two different classes. And new injectable type 2 drugs such as Symlin and Byetta are now available as well.

The good news is, you are no longer taking the last generation’s diabetes meds. The new diabetes pills should help you achieve better glucose control to prevent diabetes complications. These drugs may even help prolong the “life” of your remaining beta cells.

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

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