Chronically high hyperglycemia, or high glucose, is referred to as a condition known as diabetes mellitus (DM). Type 2 DM is the most common form of the disease that affects almost 10 percent of the U.S. population, according to the Centers for Disease Control. This represents a 5 percent rise in DM cases since the early 1980s and has prompted an increase in demand for new and improved treatment and management options. As a result, there are several drug classes on the market that can effectively control DM.
Biguanides
First-line drug therapy is the best option for any drug. In the case of type 2 diabetes, the first line drug class is biguanides. Biguanides work by several mechanisms that lead to the reduction of glucose levels in the bloods. Biguanides act on the liver to reduce the production of glucose, the pancreas to increase the synthesis and secretion of insulin and the peripheral tissues to improve tissue sensitivity to insulin. All three mechanisms help reduce overall glucose load. Only only one drug exists in this class: Metformin.
Sulfonylureas
Second-line drug therapy is the next best option for a medication regimen. For type 2 diabetes, the second-line drug option is a sulfonylurea. This a sulfur-containing drug that works directly at the site of insulin production--the pancreas. The pancreas releases insulin after a meal to allow glucose to enter the cells for use by tissues. Sulfonylureas increase the synthesis of insulin, increasing its effectiveness. Sulfonylureas can be safely used in combination with other classes of anti-hyperglycemic drugs. Sulfonylureas are the oldest class of glucose control drugs. Glyburide (glynase) and Glipizide (glucotrol) are examples of commonly used drugs in this class.
Thiazolidinediones
Another class of drugs--thiazolidinediones--focuses its actions on tissues--the site where insulin action takes place. By amplifying tissue response to insulin or improving insulin resistance, glucose movement from the blood into the cells is greatly improved. Thus, this reduces blood glucose levels significantly, according to Johns Hopkins. This class of drugs is used when patients require a large improvement in long-term management of glucose. Caution is used when managing type 2 diabetes with other diseases such as heart failure or conditions that may be worsened by fluid retention. A known side effect of thiazolidinediones is fluid retention. Some common drugs among the thaizolidinediones are Avandia (rosiglitazone) and Actos (pioglitazone).
Alpha-Glucosidase Inhibitors
This class of drugs indirectly affects hyperglycemia by acting on the intestines to reduce absorption of glucose at its source. This class of drugs is not as effective as biguanides, sulfonylureas or thiazolidediones and is used when minimal changes in glucose control are needed. Typically, they are used in combination with other drugs. These drugs are usually not well tolerated as they cause a number of gastrointestinal symptoms. Examples of alpha-glucosidase inhibitors are Arcabose (precose) and Meglitol (glyset).
Combination Drugs
In some cases, the aforementioned drug classes are packaged together in combination as one pill. This reduces the number of medications taken and makes dosing easier. Avandamet is a combination of metformin and rosiglitazone, while Avandaryl is a combination of rosiglitazone and glimepiride. Finally, Metaglip is a combination of glipizide and metformin. Each drug is chosen by a physician based on the individual patient and their specific needs for glucose control.
