DPP-4 inhibitors. DPP-4 inhibitors work in a way similar to that of GLP-1 receptor agonists. But while those drugs mimic the naturally occurring hormone GLP-1, DPP-4 inhibitors block the action of an enzyme (known as DPP-4) that breaks down GLP-1 in the body. By slowing the effects of this enzyme, DPP-4 inhibitors allow GLP-1 to stay in the body longer (where the hormone increases insulin production and reduces the release of glucose from the liver).
Insulin. Insulin is the hormone that allows cells throughout the body to use glucose in the blood for energy. People with Type 2 diabetes often use insulin injections to overcome insulin resistance by increasing the amount of insulin in the body. The two broad categories of injected insulin are basal insulin, which provides a steady level of insulin throughout the day; and mealtime insulin, which is used to “cover” the expected rise in blood glucose following a meal. Compared with other drugs used to treat Type 2 diabetes, insulin has the greatest ability to lower blood glucose and A1C. That’s because unlike most drugs, doses of insulin can usually be increased (or decreased) to whatever level is needed to achieve desired results.
Meglitinides. This class of drugs works in a way very similar to that of sulfonylureas, leading to increased insulin production in the pancreas. However, meglitinides are short-acting, taking effect within 15–30 minutes of being ingested and lasting for only 4–6 hours. They should therefore be taken within 30 minutes of beginning a meal and are usually taken three times a day (but skipped if a meal is skipped).
Alpha-glucosidase inhibitors. This class of drugs slows the breakdown of complex carbohydrates, delaying the absorption of glucose from the digestive tract, and resulting in less of a rise in blood glucose level following a meal.
Colesevelam. This cholesterol-lowering drug is also approved to help lower blood glucose in people with Type 2 diabetes. It is believed to work by reducing the absorption of carbohydrates by the digestive system.
Bromocriptine. A special, quick-release formulation of bromocriptine is believed to lower blood glucose levels in people with Type 2 diabetes by helping to regulate the circadian rhythm (the normal cycle of hormones and other physiological processes throughout the day).
Pramlintide. Pramlintide is a synthetic version of amylin, a hormone that is normally released from the beta cells of the pancreas along with insulin. It is taken along with insulin before meals to regulate blood glucose levels after meals.
(Click here to learn more about drugs that are used for treating diabetes.)
What’s right for you
While the ADA recommends only certain treatments and the order in which they should be prescribed, its guidelines also recognize that people with diabetes have individual needs to which therapies should be tailored. If your blood glucose control is not where you want it or you’re troubled by side effects, there may be something else on the menu of options that’s right for you. Talk to your doctor, pharmacist, or diabetes educator if you have any questions or doubts about your current treatment.