Diabetes Medications | List of Non-Insulin Anti-Diabetic Drugs

Diabetes medications or antidiabetic medicines are drugs that can regulate the blood glucose levels and are therefore useful in the treatment of diabetes mellitus (sugar diabetes). The diabetic medications can be broadly categorized as the insulins and non-insulin antidiabetics drugs.

Non-insulin antidiabetic drugs are also referred to as oral antidiabetic drugs (oral hypoglycemic or oral antihyperglycemic drugs). With introduction of some parenteral drugs for diabetes in the last few years, a generalized use of ‘oral’ antidiabetic medicine for non-insulin antidiabetic drugs is not accurate. Many of the drugs in this group do not actually cause hypoglycemia, but rather they show antihyperglycemic effects. All the traditional oral antidiabetic drugs are indicated only in type 2 diabetes.

List of Diabetes Drugs

The non-insulin diabetes medicines fall into several classes based on their mechanism of action. These are :

  1. Sulfonylureas
  2. Other insulin secretagogues
  3. Biguanides
  4. Thiazolidinediones
  5. Alpha-glucosidase inhibitors
  6. Dipeptidyl peptidase-4 (DPP-4) inhibitors
  7. Glucagon-like-polypeptide 1 (GLP-1) analogues (incretin mimetics)
  8. Amylin analogue

Combination Therapy

Many oral antidiabetic drugs are used in combination with drugs of other groups and some are available as fixed dose combinations (like glyburide plus metformin, glipizide plus metformin, rosiglitazone plus metformin, rosiglitazone plus glimepiride). The combination therapy is made use in patients who are not well controlled with one drug.

Sulfonylureas and Other Secretagogues

Glimepiride, Glyburide (Glibenclamide), Glipizide, Gliclazide

These are drugs that stimulate the release of insulin from the beta cells of the pancreas. First generation sulfonylureas are rarely used. However, the second generation sulfonylureas like glimepiride, glyburide (glibenclamide), glipizide, and gliclazide are widely used for the management of diabetes mellitus. There are other insulin secretagogues like repaglinide and nateglinide.

These drugs, its actions, side effects and contraindications are discussed in detail under Sulfonylurea Drug Information.

Biguanides

Metformin

These drugs help to control blood glucose levels by decreasing the production of glucose in the liver and increasing the uptake of glucose by muscle and fat cells by enhancing the action of insulin. Along with sulfonylureas, metformin is the most widely used oral diabetes medication for type 2 diabetes.

The actions, side effects and contraindications of metformin are discussed in detail under Metformin.

Thiazolidinediones

Pioglitazone, Trovaglitazone, Rosiglitazone

These drugs enhance the effect of insulin by increasing the sensitivity of fat and muscle cells to insulin thereby promoting the uptake of glucose. It also reduces glucose output from the liver. Thiazolidinediones has this effect by binding with a receptor known as PPAR-gamma and regulating certain genes that affect glucose and lipid metabolism. These drugs are also used for insulin resistance.

The actions, side effects and contraindications of these drugs are discussed in detail under Thiazolidinediones.

Alpha-Glucosidase Inhibitors

Acarbose, Miglitol

These drugs block the digestive enzymes that are involved in digesting carbohydrates. This prevents the digestion and subsequent absorption of carbohydrates from the gut and prevents the rise of blood glucose levels due to carbohydrate absorption. Alpha-glucosidase inhibitors are also commonly known as starch blockers or carb blockers.

The actions, side effects and contraindications of these drugs are discussed in detail under Alpha-Glucosidase Inhibitors.

Incretin Mimetics

Exenatide, Liraglutide

Also known as glucagon-like peptide (GLP-1), these drugs act like the gut hormones known as incretins and stimulate insulin secretion in accordance with the ingested glucose. These drugs also reduce the secretion of glucagon after a meal, slows gastric emptying and decreases appetite.

The actions, side effects and contraindications of these drugs are discussed in detail under Incretin Mimetics.

Dipeptidyl Peptidase-4 (DPP-4) Inhibitors

Sitagliptin, Saxagliptin

These drugs block the enzyme dipeptidyl peptidase-4 (DPP-4) which breaks down the incretins. This allows the naturally occurring incretins to act for longer and thereby bring down the blood glucose levels. It will also enhance the other effects of the incretins.

The actions, side effects and contraindications of these drugs are discussed in detail under Dipeptidyl Peptidase-4 (DPP-4) Inhibitors.

Amylin Analogues

Pramlintide

These drugs mimic the action of amylin, the naturally occurring hormone that is secreted along with insulin. It reduces the secretion of digestive juices thereby affecting digestion and slows gastric emptying. This slows the rise in blood glucose levels after eating.  It also inhibits glucagon and therefore reduces the release of stored glucose.

The action, side effects and contraindications of these drugs are discussed in detail under Amylin Mimetics.