Many people can manage their diabetes without medications through healthy diet, exercise, not smoking and losing weight. Oral medications and insulin can be prescribed to lower blood sugar.
Other risk factors include age, family history, high levels of certain fats in the blood (hyperlipidemia) and race or ethnicity. It is also more common in overweight people.
Metformin
Metformin is the most commonly used biguanide, a class of drugs that reduces glucose production in the liver and intestine. It has been used for more than 60 years to treat type 2 diabetes, and is inexpensive and well tolerated. It has also been shown to protect against microvascular and macrovascular complications, including cardiovascular disease. It may also help prevent Alzheimer’s disease and slow the aging process.
It is often combined with insulin to achieve the best results. It comes in tablets, liquids, and powders that can be added to food or beverages. Metformin should be taken with a meal, and water is recommended. It is important to remember to take it regularly and at the same time each day. The Patient Information Leaflet inside the medication box will provide detailed instructions on how to take it.
It can be given to people of all ages, although it is most often prescribed to adults. It is important to check blood sugar levels frequently, especially after meals and exercise. A low blood sugar can occur if you skip a meal, have an upset stomach or diarrhea, or drink less fluid than usual. If this happens, you should contact your doctor or pharmacist for advice.
Some people are more likely to develop low blood sugar than others, such as those with other conditions that can cause this problem. These include gastrointestinal issues; kidney problems; or liver or heart disease. It is also important to tell your doctor if you have any other health conditions or are taking any other medications, including vitamins, minerals, and over-the-counter medicines.
Several studies have shown that metformin can significantly lower the risk of developing type 2 diabetes. This is particularly true in subgroups of the DPP in which metformin was as effective as lifestyle intervention. These include individuals with a BMI of 30 or above, younger individuals, and women who have had gestational diabetes.
The American Diabetes Association recommends metformin as the first-line treatment for prediabetes. It can be given with insulin or as a monotherapy and is well tolerated, with few side effects. However, it is not recommended to treat prediabetes with metformin alone, because it has been shown that lifestyle interventions are more effective than the drug in reducing the progression to type 2 diabetes.
GLP-1 receptor agonists
GLP-1 receptor agonists are medications that mimic the natural hormone glucagon-like peptide-1 (GLP-1) produced by cells in the intestine. These medications help control blood sugar in people with type 2 diabetes by inhibiting the secretion of glucagon and slowing stomach emptying. GLP-1 agonists also increase feelings of fullness and reduce food intake. They can be used to treat type 2 diabetes and obesity.
In a cardiovascular outcome study, injectable GLP-1 RAs significantly reduced the rates of vascular events in people with type 2 diabetes. However, there are some risks associated with these medications. For example, they may cause abdominal discomfort or nausea. Moreover, they may interact with antiplatelet and anticoagulant medications and increase the risk of bleeding. Therefore, patients should consult their physicians before starting these medications.
A patient-centered, holistic interprofessional team comprising a primary care physician, advanced practice practitioner, endocrinologist, pharmacist, dietician, and nursing staff should be utilized when prescribing GLP-1 agonists to type 2 diabetics and obese individuals. The team should communicate effectively to determine the patient’s risk and benefits of using these medications. They should also discuss the patient’s goals and work together to monitor therapy to optimize patient outcomes.
SGLT-2 inhibitors and GLP-1 agonists can be prescribed in combination with other antidiabetic agents, including metformin, to improve glycemic control in type 2 diabetes patients. In addition, these medications can lower body weight and triglyceride levels in many individuals. They can also decrease the risk of heart disease and lower blood pressure. However, they should not be given to pregnant women.
The American Diabetes Association’s 2022 guidelines recommend adding a long-acting GLP-1 receptor agonist or SGLT-2 inhibitor to existing metformin therapy as first-line treatment for type 2 diabetes and established atherosclerotic cardiovascular disease, chronic kidney disease, or heart failure, regardless of glycemic target. ADA guidelines also recommend considering an SGLT-2 inhibitor prior to initiating basal insulin in patients with type 2 diabetes and heart failure or renal impairment.
The use of GLP-1 agonists is also associated with a significant reduction in pregnancy-associated weight gain, and they can be used as an adjunctive therapy in pregnancies of women with type 2 diabetes and polycystic ovary syndrome (PCOS). In a recent study, liraglutide 3 mg once daily enabled weight loss and lowered androgen levels in 55 overweight and obese women with PCOS.
SGLT2 inhibitors
SGLT2 inhibitors help people with type 2 diabetes by helping the kidneys remove excess glucose through urine. These medications work with other treatments to improve glycemic control and reduce the risk of heart failure and chronic kidney disease. They can also reduce the need for dialysis and improve renal outcomes in patients with type 2 diabetes and CKD.
Unlike other diabetes drugs, SGLT2 inhibitors have a low risk of hypoglycemia, making them an excellent addition to sulfonylureas and insulin therapy. However, they may increase the risk of developing diabetic ketoacidosis (DKA) in those with long-standing T2D. This is thought to be due to the suppression of insulin, increased glucagon levels and masking of hyperglycemia by enhanced glucosuria. Nevertheless, a few studies have shown that SGLT2 inhibitors can significantly decrease DKA episodes in those with a history of long-standing T2D.
Clinical trials have demonstrated that SGLT2 inhibitors can significantly improve cardiovascular outcomes and renal outcomes in people with diabetes. They can slow the progression of CKD and decrease albuminuria. They can also prevent heart failure flare-ups and decrease hospitalizations for HF. In four large randomized controlled trials, a significant benefit of SGLT2 inhibitors was seen in the primary and secondary prevention of cardiovascular events and renal outcomes. These trials included the EMPA-REG OUTCOME and CANVAS Program, which tested the effect of empagliflozin and canagliflozin, respectively.
These trials have also shown that SGLT2 inhibitors can have benefits in nondiabetic kidney disease patients, even without diabetes. They can delay CKD progression, improve glycemic control, and reduce proteinuria. They can also reduce the need for dialysis in CKD patients and help them live longer.
Some types of SGLT2 inhibitors can cause serious or life-threatening side effects, including kidney problems, nerve damage, and severe bladder issues. Taking the medication as prescribed is key to keeping it safe. Your doctor may recommend frequent blood tests to ensure that your body is responding well to the medicine. They will also advise you to check your blood sugar before having a sexual intercourse, as SGLT2 inhibitors can cause serious urinary tract infections in men. Moreover, women of childbearing age must not take these medications because they can be harmful to the fetus.
Insulin
Insulin is a hormone that regulates blood sugar. It comes from beta cells in the islets of Langerhans in the pancreas. Insulin works by binding to receptors on cells and lowering their glucose content. Insulin also helps cells absorb and store glucose. If the body is unable to make enough insulin or can’t use it efficiently, blood sugar levels rise. Several things can cause this, including a high-fat diet, obesity, physical inactivity and age. People with type 2 diabetes can develop insulin resistance for reasons that aren’t completely understood.
Metformin, a medicine used to treat other health problems, can help prevent or delay the need for insulin therapy. But people with type 2 diabetes still need to make healthy lifestyle changes, and they may need other medications to manage their condition. These medicines include SGLT2 inhibitors, GLP-1 agonists and insulin. These medicines can lower blood sugar and reduce the risk of complications, such as cardiovascular disease.
The most important way to manage type 2 diabetes is to check your blood sugar regularly with a fingerstick meter or a continuous glucose monitor (CGM). Follow your provider’s guidance about how often you should check your blood sugar and when. Make sure you have a plan for what to do on sick days, as getting sick can affect your blood sugar and trigger hypoglycemia.
Your healthcare team will prescribe the right kind and amount of insulin for you, and teach you how to inject it with syringes or pens or use an insulin pump. They may also prescribe other medicines to help manage your condition, such as medicines that lower blood pressure and cholesterol or low-dose aspirin to protect against heart and blood vessel diseases.
A health care professional can also suggest a support group to help you cope with the challenges of living with type 2 diabetes. These groups can offer emotional support and education about diabetes management. They can also provide useful information, such as carbohydrate counts for your favorite restaurants. You can find these groups online or by asking your healthcare provider.
