What Is the Best Medication for Diabetes?

What Is the Best Medication for Diabetes?

Diabetes is a very individual condition; the best medication for your diabetes will depend on your health, type of diabetes, lifestyle, and preferences.

Your diabetes team should work with you to find the best medication for your diabetes. The best medication will help you control your blood sugars, reduce diabetes complications and help you stay healthy and well.

The best treatment for type 2 diabetes

The best medication for your type 2 diabetes will depend on your blood sugars, your general health and how well you tolerate any side effects.

The National Institute for Health and Care Excellence (NICE) has published a type 2 diabetes treatment pathway. They recommend a holistic approach for diabetes treatment. Non-medical treatments like weight loss, dietary changes, exercise, glucose monitoring and health screening are critical components of good diabetes management. Hippocrates said:

‘Let food be thy medicine.’

That’s very true for type 2 diabetes. Many people with type 2 diabetes can return their sugar levels to normal and achieve diabetes remission by losing 15kg or more of weight. Losing weight with the support of your diabetes team can help reduce or reverse the need for diabetes medication.

According to NICE guidelines, the first drug prescribed for type 2 diabetes should be Metformin. Depending on your response, your diabetes team or GP can change it or add another oral or injected medication.

The best medication for type 2 diabetes

All medications have pros and cons; by balancing the advantages and disadvantages, you can work with your diabetes team to find the best type 2 diabetes medication for your needs.

Metformin

Metformin is a tablet that helps your body respond more effectively to insulin, suppresses glucose production in your liver and reduces glucose absorption in your bowel.

Advantages:

  • Improves diabetes control and prevents diabetes complications
  • Doesn’t cause weight gain
  • Unlikely to cause hypos, although it might if you also take a sulfonylurea or drink alcohol
  • Generally well tolerated
  • Available as a modified release formulation to reduce side effects

Disadvantages:

  • Can cause bloating, diarrhoea and vomiting
  • May cause an unpleasant taste in your mouth
  • Can cause anaemia
  • Reduces appetite

Sulfonylureas

Sulfonylurea is a family of medicines that includes the drugs Glibenclamide and Gliclazide. They increase insulin production in your pancreas, which reduces blood glucose levels.

Advantages:

  • Improves diabetes control and prevents diabetes complications
  • Available in many different formulations
  • Usually well-tolerated

Disadvantages:

  • May cause hypos, especially if you miss a meal
  • Can lead to weight gain
  • Some people may develop an itchy, red rash during the first 6-8 weeks of treatment

Alpha-glucosidase inhibitors

Acarbose is an alpha glucosidase inhibitor. It acts to block the absorption of starchy foods from your diet.

Advantages:

  • Help glucose levels rise more gradually after eating
  • Prevents blood glucose spikes after a meal

Disadvantages:

  • Can cause abdominal pain and bloating
  • Can lead to diarrhoea and GI disturbance

Prandial glucose regulators

Repaglinide and Nateglinide are both prandial glucose regulators or glinides. They act similarly to sulfonylureas, boosting insulin production in your pancreas. They work quickly and for a short time. You should usually take them half an hour before a meal or snack.

Advantages:

  • Improved blood glucose control and reduced HbA1c
  • Allows greater spontaneity and flexibility with food and lifestyle
  • Suitable for people who eat erratically or have non-routine lifestyles
  • Reduced spiking of blood glucose levels after meals

Disadvantages:

  • Can cause hypos
  • May trigger and allergic skin reactions
  • Uncommonly can cause liver problems
  • Can cause abdominal pain and bowel disturbance, including nausea, diarrhoea and constipation

Glitazones

Glitazones are also known as thiazolidinediones; an example is Pioglitazone. Glitazones reduce insulin resistance and help your natural insulin work more effectively.

Advantages:

  • Improved diabetes control and lower HbA1c
  • Reduce blood pressure
  • Improve the balance of healthy to unhealthy cholesterol in your blood

Disadvantages:

  • Linked with oedema and risk of heart failure
  • Worsening of osteoporosis and increased fracture risk
  • Weight gain

Gliptins

Gliptins are also called DPP-4 inhibitors; examples include Sitagliptin and Saxagliptin. They block the enzyme DPP-4, which breaks down incretin hormones. Gliptins prevent DPP-4 from breaking down incretin. Levels of incretin in the gut rise, stimulating your body to produce more insulin and less glucose.

Advantages:

  • Improved diabetes control and a reduced HbA1c
  • Doesn’t cause weight gain
  • Unlikely to cause hypos

Disadvantages:

  • Gastrointestinal disturbance including constipation, vomiting, nausea, diarrhoea and indigestion
  • Acute pancreatitis
  • Liver inflammation
  • Headache
  • Itchy rash and allergies
  • Muscular aches and joint pain

SGLT2 Inhibitors

SGLT2 is short for sodium-glucose like co-transporter 2 inhibitors; examples include Dapagliflozin and Empagliflozin. The tablets block your kidneys from reabsorbing glucose. You will pass out more glucose in your urine so that sugar levels in your blood will decrease.

Advantages:

  • Improved diabetes control and a lower HbA1c
  • Can help with kidney disease
  • Can help people with heart failure

Disadvantages:

  • Diabetic ketoacidosis has been linked to SGLT2 inhibitors even with optimal or near-optimal blood glucose levels
  • Hypoglycaemia
  • Increased risk of genital and urinary tract infections
  • Urinary frequency
  • Hypotension and dizziness on standing
  • Constipation

Incretin mimetics

Incretin mimetics are also known as GLP1 medications. An example includes Liraglutide or Saxenda. They are relatively new injectable diabetes medications. They stimulate insulin release from your pancreas and decrease glucagon production, and slow stomach emptying.

Advantages:

  • Improved diabetes control and a reduced HbA1c
  • Get full more quickly when eating
  • Reduced hunger
  • Weight loss

Disadvantages:

  • Needs to be injected daily or weekly, depending on the drug
  • Can cause nausea, vomiting, diarrhoea and constipation
  • Problems with hypos
  • Insomnia and fatigue
  • Dry mouth
  • Increased risk of gallstones

The best medication for type 1 diabetes

When you have type 1 diabetes, your pancreas can’t produce the hormone insulin. Insulin is essential to your body. It acts like a key, unlocking your cells so that they can burn glucose for energy. Without insulin, your body cells don’t have the fuel they need to function; they will fail and die. You need replacement insulin to stay alive, making insulin the best and most essential medication for type 1 diabetes.

Insulin is broken down in your stomach, so it can’t be taken as a tablet. Instead, you need to inject it under your skin. You can use a fine needle and specially-designed insulin syringe to inject insulin- but most people now find it more comfortable and convenient to use insulin pens or insulin pumps.

Insulin pumps for type 1 diabetes

Insulin pumps are electronic devices that deliver small amounts of insulin into your body twenty-four hours a day.

Insulin pumps administer the same medication as pens and syringes -insulin- but they more effectively replicate your body’s natural pattern of insulin release. You programme the pump to deliver a background insulin level around the clock and add bolus doses when you have a meal or snack.

An insulin pump can improve your diabetes control, prevent diabetes complications, reduce the risk of dangerous highs and lows, and improve your quality of life.

Sources: 

https://www.diabetes.org.uk/guide-to-diabetes/managing-your-diabetes/treating-your-diabetes/insulin

https://www.nhs.uk/conditions/type-2-diabetes/understanding-medication/

https://www.mayoclinic.org/diseases-conditions/type-2-diabetes/in-depth/diabetes-treatment/art-20051004

https://www.diabetes.org.uk/guide-to-diabetes/managing-your-diabetes/treating-your-diabetes/tablets-and-medication

https://www.diabetes.co.uk/diabetes-medication/

https://www.nice.org.uk/guidance/ng28

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