Diabetes medication

This article is about the treatment of diabetes mellitus. For the treatment of diabetes insipidus, see Diabetes insipidus.

Drugs used in diabetes treat types of diabetes mellitus by decreasing glucose levels in the blood. Most GLP-1 receptor agonists (liraglutide, exenatide, tirzepatide, pramlintide and others) are administered by injection. Other anti-diabetes medications (including semaglutide as Rybelsus) are administered orally and are thus called oral hypoglycemic agents or oral antihyperglycemic agents. (Semaglutide is available both as a pill and as an injection.) There are different classes of hypoglycemic drugs, and selection of the appropriate agent depends on the nature of the diabetes (Type I vs Type II), the age and situation of the person, as well as other patient factors.

Type 1 diabetes is an endocrine disorder characterized by hyperglycemia due to autoimmune destruction of insulin-secreting pancreatic beta cells. Insulin is a hormone needed by cells to take in glucose from the blood. Insufficient levels of insulin due to Type 1 diabetes can lead to chronic hyperglycemia and eventual multiorgan damage, resulting in renal, neurologic, cardiovascular, and other serious complications. The treatment for Type 1 diabetes involves regular insulin injections.

Type 2 diabetes, the most common type of diabetes, occurs when cells exhibit insulin resistance and become unable to properly utilize insulin. Insulin resistance requires the pancreas to compensate by increasing insulin production. Once compensation fails, chronic hyperglycemia can manifest and type 2 diabetes develops. Treatments include dietary changes emphasizing low glycemic index food, physical activity to improve insulin sensitivity, and medications that (1) increase the amount of insulin secreted by the pancreas, (2) increase the sensitivity of target organs to insulin, (3) decrease the rate at which glucose is absorbed from the gastrointestinal tract, and (4) increase the loss of glucose through urination.

Several drug classes are indicated for use in type 2 diabetes and are often used in combination. Therapeutic combinations may include several insulin isoforms or varying classes of oral antihyperglycemic agents. As of 2020, 23 unique antihyperglycemic drug combinations were approved by the FDA. The first triple combination of oral anti-diabetics was approved in 2019, consisting of metformin, saxagliptin, and dapagliflozin. Another triple combination approval for metformin, linagliptin, and empagliflozin followed in 2020.

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