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Oral Diabetes Medicines

Diabetes medications can be categorized into unique classes based on how the medicines work in the body. Medicines that belong to the same class generally work in the same way to lower blood sugar levels.
For this reason, a person is unlikely to be on more than one medicine from the same class. Instead, a healthcare provider will choose a particular drug from a class based on other things, such as side effects, dosing, and cost.
 The common classes of diabetes medicines include:
  • Alpha-glucosidase inhibitors
  • Biguanides
  • Dipeptidyl peptidase-4 inhibitors (DPP-4 inhibitors)
  • Ergot alkaloids
  • Meglitinides
  • Sulfonylureas
  • Thiazolidinediones ("glitazones")
  • Sodium-glucose co-transporter 2 inhibitors (SGLT2 inhibitors)
  • Bile acid sequestrants.
Alpha-Glucosidase Inhibitors
Alpha-glucosidase inhibitors work by slowing down the absorption of carbohydrates from the gastrointestinal (GI) tract. This helps lower post-meal blood sugar levels. Available medicines in this class include acarbose (Precose®) and miglitol (Glyset®).
Metformin (Glucophage®) is the only biguanide available. It works by helping cells in the body take up and use insulin more effectively. This class of medicines also decreases the amount of glucose made by the liver. Metformin is also available in an extended-release form (metformin ER [Glucophage XR®, Glutametz®, and Fortamet®]) and as metformin oral solution (Riomet®).
DPP-4 Inhibitors
As previously mentioned, Oseni contains the DPP-4 inhibitor alogliptin. This class of medicines is also sometimes simply called "gliptins." They work by slowing the breakdown of incretin, a hormone that helps to control blood sugar. Other DPP-4 inhibitors include:
Ergot Alkaloids
Ergot alkaloids are more commonly known to treat Parkinson's disease and migraine headaches. However, there is one ergot alkaloid approved for the treatment of diabetes: bromocriptine (Cycloset®).
Although the exact way this drug works to control blood sugar is not completely understood, it is thought to work by binding to and stimulating dopamine receptors. People with diabetes have low dopamine levels in the morning, which may interfere with the body's ability to control blood sugar. By increasing dopamine receptor activity, bromocriptine lowers blood sugar without increasing insulin.
Meglitinides work by stimulating the pancreas to make more insulin. They are quite effective at controlling blood sugar, but also carry the risk of dangerously low blood sugar (hypoglycemia). Available meglitinides include nateglinide (Starlix®) and repaglinide (Prandin®).
This class of medicines also works by stimulating insulin secretion by the pancreas. Like meglitinides, they are quite effective, but also carry the risk for hypoglycemia. Many sulfonylurea medicines are available, including:
Glitazones work by making the body more sensitive to insulin, which means they help the body use its natural insulin more effectively. As previously mentioned, Oseni contains the glitazone pioglitazone. The other available glitazone is rosiglitazone (Avandia®).
Sodium-Glucose Co-Transporter 2 Inhibitors
SGLT2 inhibitors work by causing glucose to be lost from the bloodstream into the urine. There are three approved medications in this class: Invokana® (canagliflozin), Jardiance® (empagliflozin), and Farxiga™ (dapagliflozin). These medications tend to lower blood pressure and cause a small amount of weight loss, which can often be desirable effects in people with type 2 diabetes.
Bile Acid Sequestrants
Often overlooked as a diabetes drug, Welchol® (colesevelam) is a bile acid sequestrant that was initially approved for treating high cholesterol but was later approved for treating type 2 diabetes. It helps to lower both blood sugar and cholesterol levels, which can be very useful in many people with diabetes. The downside is that the usual dosage involves taking six tablets a day. It can also bind with (and therefore interact with) some other drugs.
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