Updated 16 February 2017

Which diabetes medication is the best?

With so many products on the market, it can be difficult to choose the most effective diabetes medication for your needs.

Type 2 diabetes is often referred to as the “silent killer”, and many people don’t even know they have the disease – until it is too late.

According to the World Health Organisation (WHO), in 2012 1.5 million deaths were directly caused by this serious metabolic disorder.

Type 2 diabetes is preceded by insulin resistance and progressive insulin secretory defects, whereas type 1 is usually diagnosed in children, occurring when the body does not produce any insulin.

Fortunately there are many treatment options for type 2 diabetes, and we compared the most common diabetes medications.

Read: FDA approves 1st 'artificial pancreas' for type 1 diabetes

1. Biguanides

Names: Metformin, Glucophage, Glumetza

How it works: This is the most common medication for type 2 diabetes. It works by decreasing the amount of glucose that your liver releases and helps to restore a natural response to insulin.

Effectiveness: Most experts agree it might be an old drug, but it’s still the most widely used and probably the most effective medication. A recent study from the State University of Rio de Janeiro found it’s still the first line of treatment, even when used in combination with other medication.

Possible side-effects: An upset stomach, vomiting, nausea

2. Sulfonylureas

diabetes medication


Names: Diabinese, Tolinase, Glipizide

How it works: These medications lower blood glucose levels and increase the amount of insulin produced by the pancreas.

Effectiveness: Sulfonylurea drugs have been in use since the 1950s and a lot of newer medications have similar workings (and are generally cheaper). But many physicians still prescribe these medications when Biguanides are either not as effective, or when the side-effects of the latter are too severe.

Possible side-effects: Hypoglycaemia, weight gain

Read: Statins' benefits outweigh diabetes risk: study

3. Dpp-4 Inhibitors

diabetes medication


Names: Januvia, Onglyza, Galvus

How it works: These medications stop an enzyme called DPP-4 from developing too fast. This allows incretin to stay in the body for longer (DPP-4 removes incretin from the body). This process allows insulin to be released.

Effectiveness: Many studies have shown the effective of these drugs, especially in patients who do not make enough incretin. It also carries a low risk of hypoglycaemia and the side-effects are less severe than some other diabetes medications.

Possible side-effects: upper respiratory tract infection, sore throat, and diarrhoea

4. Thiazolidinediones

diabetes medication


Names: Actos, Avandia

How it works: Thiazolidinediones improve insulin sensitivity and lower insulin resistance in muscles and fat. It activates certain genes involved in fat synthesis and carbohydrate metabolism. Glucose produced by the liver is also lowered as a result of these medications.

Effectiveness: These drugs might take several days before making a noticeable differences and a few weeks until taking complete effect.

Possible side-effects: Risk of heart failure, macular oedema, hypoglycaemia

5. Insulin therapy

diabetes medication


Names: Lantus

How it works: In most patients diabetes is a progressive illness and insulin reserves can become depleted. This is when insulin replacement is necessary, and these days it’s often prescribed early in a treatment regimen. 

Effectiveness: Insulin must be injected and, depending on your needs, you might be required to inject a few times a day. While this type of treatment is effective in itself, studies have shown compliance might be an issue.

Possible side-effects: Hypoglycaemia, swelling or itching at the injection site

Read more:

Diabetes linked to hearing impairment

Diabetes during pregnancy could harm baby

SEE: What can type 2 diabetes do to your body?



Ask the Expert

Diabetes expert

Dr. May currently works as a fulltime endocrinologist and has been in private practice since 2004. He has a variety of interests, predominantly obesity and diabetes, but also sees patients with osteoporosis, thyroid disorders, men's health disorders, pituitary and adrenal disorders, polycystic ovaries, and disorders of growth. He is a leading member of several obesity and diabetes societies and runs a trial centre for new drugs.

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