Oral agents
These are used to treat type 2 diabetes when diet and physical activity no longer control the rising blood glucose. Oral agents are used in a combination with diet and physical activity. Drugs used are:
Sulphonylureas
- Stimulates the release of insulin from the pancreas
- Increases sensitivity of peripheral tissue to circulating insulin.
Biguanides
- Appears to inhibit the formation of glucose in the liver and decrease the excretion of glucose
- Increases peripheral utilisation of glucose.
Alpha-glucosidase inhibitors
- Delays absorption of carbohydrate.
Prandial glucose regulators
- Stimulates the release of insulin from pancreas if needed to control a post- prandial blood glucose rise.
Glitazones
- Increases cellular sensitivity to insulin with no effect on insulin secretion.
Newer agents for blood glucose control
Information about use of newer agents for blood glucose control in adults with type 2 diabetes is covered by the NICE clinical guideline published in 2009 (CG87) which is a partial update of NICE clinical guideline 66 and updates and replaces some of the recommendations. For the recommendations on these newer agents and their positions within the care pathway see NICE (2009) Type 2 diabetes – newer agents (partial update of CG66) .
Resources
You will find here links to evidence-based resources which support this topic. You may also want to refer to information about the national service frameworks and strategies across the UK.
Some of the resources on this page are in PDF format - see how to access PDF files.
Guidelines and guidance
NICE guidance by topic: Endocrine, nutritional and metabolic
This section of the NICE website includes details of all the current guidelines and guidance published by NICE which is relevant to diabetes.
NICE pathways Diabetes: Blood-glucose-lowering therapy for type 2 diabetes
NICE pathways brings together all related NICE guidance and associated products in a set of interactive topic-based diagrams. This section describes pathways for consideration of different drug treatments.
Systematic reviews and evidence summaries
For more information about Cochrane Systematic Reviews, examples of which appear below, visit the page within this resource on the Cochrane Library.
Cochrane Review: Risk of fatal and nonfatal lactic acidosis with metformin use in type 2 diabetes mellitus
The main objective of this review was to assess the incidence of fatal and nonfatal lactic acidosis with metformin use compared to placebo and other glucose-lowering treatments in patients with type 2 diabetes mellitus.
Cochrane Review: Metformin monotherapy for type 2 diabetes mellitus
The aim of this review was to assess the effects of metformin monotherapy on mortality, morbidity, quality of life, glycaemic control, body weight, lipid levels, blood pressure, insulinaemia, and albuminuria in patients with type 2 diabetes mellitus.
Cochrane Review: Metformin added to insulin therapy for type 1 diabetes mellitus in adolescents
This review aimed to assess the effects of metformin added to insulin therapy for type1 diabetes mellitus in adolescents and whether it improves insulin sensitivity.
Cochrane Review: Insulin and oral agents for managing cystic fibrosis-related diabetes
This review examined the evidence that examine the evidence that, when treated with agents for managing diabetes, people with cystic fibrosis improve their sugar metabolic control resulting in beneficial impact on lung function and the ability to maintain optimal weight.
Cochrane Review: Alpha-glucosidase inhibitors for type 2 diabetes mellitus
This review assessed the effects of alpha-glucosidase inhibitors in patients with type 2 diabetes mellitus.
Cochrane Review: Meglitinide analogues for type 2 diabetes mellitus
The aim of this review was to assess the effects of meglitinide analogues, which are a class of oral hypoglycaemic agents that increase insulin secretion, in patients with type 2 diabetes mellitus.
Cochrane Review: Pioglitazone for type 2 diabetes mellitus
This review assessed the effects of pioglitazone in the treatment of type 2 diabetes.
Cochrane review: Rosiglitazone for type 2 diabetes mellitus
This aimed to assess the effects of rosiglitazone in the treatment of type 2 diabetes and recommends that "new studies should focus on patient-orientated outcomes to clarify the benefit-risk ratio of rosiglitazone therapy".
Other resources
BMJ (2010) Long term treatment with metformin in patients with type 2 diabetes and risk of vitamin B-12 deficiency: randomised placebo controlled trial
This research study found that long term treatment with metformin increases the risk of vitamin B-12 deficiency. Findings “suggest that regular measurement of vitamin B-12 concentrations during long term metformin treatment should be strongly considered”.
Department of Health (2004) Management of Medicines - a resource to support implementation of the wider aspects of medicines management for the National Service Frameworks for Diabetes, Renal Services and Long-Term Conditions
This guidance includes examples of innovative practice which primary care trusts (PCTs) and NHS trusts may want to implement.
Diabetes UK: medication for type 2 diabetes
General information from Diabetes UK on the different types of tablets used in the treatment of diabetes.
Merck Manuals Online Medical Library: Diabetes treatment
Merck & Co, Inc. is a pharmaceutical company and the Merck Manuals are a series of healthcare books for professionals and consumers. The online version is freely available with additional photographs, audio and video material not available in the printed form.
There are separate resources lists for other specific aspects of treatment and lifestyle - see Treatment and lifestyle topics.