When it comes to non-insulin medications that treat type 2 diabetes, there are a lot of options. Read on to learn more about these medications, as well as factors that play into which one is right for you.

Metformin is generally the preferred initial medication for treating type 2 diabetes unless there’s a specific reason not to use it. Metformin is effective, safe, and inexpensive. It may also reduce the risk of cardiovascular events.

Metformin has beneficial effects when it comes to reducing A1C. It may also help with weight management. It works by reducing the amount of glucose your liver produces.

Other classes of diabetes medications are also available, each with its own risks and benefits.

Sulfonylurea

Medications in this class include glipizide, glyburide, and glimepiride. These medications can be inexpensive but may cause hypoglycemia (low blood sugar) and weight gain.

Insulin sensitizer

This medication, pioglitazone, is effective and has no risk of hypoglycemia. However, it may increase the risk of cardiovascular disease and weight gain.

Glucagon-like peptide-1 (GLP-1) receptor agonists

Several types of this medication are available, including exenatide (Byetta, Bydureon), liraglutide (Victoza, Saxenda), and dulaglutide (Trulicity). Some of these medications are given by daily injection, and others by weekly injection.

Semglutides, like Ozempic, are also given by weekly injection.

An oral form of semaglutide (Rybelsus) can be taken once per day. This type of medication is effective and may benefit the heart and help with weight loss. But it may also cause side effects, such as nausea and diarrhea.

Dipeptidyl peptidase-4 inhibitors (DPP-4 inhibitors)

Several medications are available in this class. They’re all brand-name drugs, including sitagliptin (Januvia), saxagliptin (Onglyza), and linagliptin (Tradjenta).

They’re all easy-to-use, well-tolerated oral medications you take once a day. They have a mild effect on reducing blood sugar levels. Mainly, they reduce postmeal blood sugar levels.

Alpha-glucosidase inhibitor

This medication, acarbose, is rarely used. It decreases carbohydrate absorption, but gastrointestinal side effects are common.

Sodium-glucose cotransporter-2 inhibitors (SGLT-2 inhibitors)

This is the newest class of diabetes medications. These medications lower blood glucose levels by removing glucose from the body through urine.

There’s growing evidence that this class provides cardiovascular benefits as well as improved blood glucose management.

Research also suggests SGLT-2 inhibitors have benefits for the kidneys, such as slowing the progression of chronic kidney disease. Medications in this class are all brand names, including empagliflozin (Jardiance), dapagliflozin (Farxiga), canagliflozin (Invokana), and ertugliflozin (Steglatro).

Type 2 diabetes is a complex, chronic condition. Managing it effectively means using multiple risk-reduction strategies while also achieving your target goal for blood sugar regulation.

To decide which treatment plan will benefit you the most, your doctor will consider the following factors:

  • heart disease, which includes a history of heart attacks, strokes, or congestive heart failure
  • chronic kidney disease
  • the risk of low blood sugar with any particular therapy option
  • potential side effects of treatment
  • your weight and the potential for the treatment to affect weight
  • cost of the medication and insurance coverage
  • your individual preferences and if you think you’ll be able to stick with the treatment plan

Your doctor will also consider your A1C test results, which provide information about your average blood sugar levels over the last 3 months.

For most people, the goal of treatment is to lower your A1C below 7%. This target is set by the American Diabetes Association guidelines, but your doctor will help you establish the right A1C goal for you.

Several types of non-insulin medications are available for type 2 diabetes. You will most likely be prescribed Metformin initially, but other options are available depending on your individual needs.

Your doctor will be able to determine the best medication for you. They will also emphasize that in addition to medication, lifestyle changes are an important part of your overall treatment plan for type 2 diabetes.

Marina Basina, MD, is an endocrinologist specializing in diabetes mellitus type 1 and 2, diabetes technology, thyroid, and adrenal disorders. She graduated from Moscow Medical University in 1987 and completed her endocrinology fellowship at Stanford University in 2003. Dr. Basina is currently a clinical associate professor at Stanford University School of Medicine. She’s also on the medical advisory board of Carb DM and Beyond Type 1 and is a medical director of inpatient diabetes at Stanford Hospital.