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In the management of type 2 diabetes, we usually start by changing our lifestyle towards a healthier lifestyle : change in eating habits, weight loss, regular physical activity and smoking cessation. If these measures are not sufficient, the doctor will prescribe medication. Her first choice will usually be metformin.
If one medicine is not enough to properly control the level of sugar in the blood (blood sugar), another medicine can be added to the treatment. If the combination of 2 or more medicines still does not achieve the correct blood sugar levels, you may need insulin injections.
This patient guide specifically discusses medications that are used to lower blood sugar levels in type 2 diabetes. Insulin is specifically discussed in another guide.
Metformin
In Belgium, metformin is available under the brands Glucophage®, Metformax® or Metformin®. Metformin is the treatment of choice for most people with diabetes. When taken for a long time, metformin reduces cardiovascular risk. In addition, with metformin, there is no risk that the blood sugar will be too low (hypoglycemia). Metformin does not cause weight gain.
Stomach pain is the most bothersome side effect of metformin. Metformin is not indicated if you have liver or heart failure, drink too much alcohol, or have bad kidneys.
To work, metformin must be taken in a high enough dose. Your doctor will therefore gradually increase the dose until it is high enough.
Metformin is to be taken with or after a meal.
Sulphonylureas or sulphonylureas
In Belgium, the available hypoglycemic sulfonylureas are
- Glibenclamide under the Daonil® brand
- Gliclazide under the brands (Uni) Gliclazide® and Uni Diamicron®
- Glimepiride under the brands Amarylle® and Glimepiride®
- Glipizide under the brand name Minidiab®
- Gliquidone under the brand name Glurenorm®
When taken for a long time, sulfonylureas reduce the damage that diabetes can do to the small blood vessels in the kidneys and eyes.
Their main side effect is hypoglycemia. This side effect is common, especially in the elderly. There is also a risk of weight gain. Other side effects are quite rare. You cannot take sulfonylureas if your kidneys are badly functioning.
Your doctor will start by prescribing a low dose and may then gradually increase it if your blood sugar does not drop enough. Some sulfonylureas should be taken 20 to 30 minutes before a meal. Ask your doctor if this is the case.
Glinides
In Belgium, only one glinide is available: repaglinide, under the brands NovoNorm® and Repaglinide®. It is not known whether repaglinide prevents long-term vascular complications of diabetes. It can be offered to people who have high blood sugar after a meal, but only experience a slight increase in blood sugar when fasting. People with moderate kidney failure can also use glinides.
As repaglinide works quickly, it should be taken at the start of a meal.
Glitazones
In Belgium, only one glitazone is available, pioglitazone, under the brand Actos®.
This drug is not widely offered because it causes many side effects and other drugs (see other paragraphs) are more appropriate. Pioglitazone is contraindicated in people who have an insufficient heart. Fluid retention (edema) occurs in 5% of users. The drug can cause weight gain.
Gliptins (or DPP4 inhibitors)
In Belgium, the DPP4 inhibitors available are
- Alogliptin under the brand name Vipidia®
- Linagliptin under the Trajenta® brand
- Saxagliptin under the brand name Onglyza®
- Sitagliptin under the Januvia® brand
- Vildagliptin under the brand name Galvus®
It is not known whether these drugs prevent the vascular complications of diabetes in the long term.
They are not known to have serious and frequent side effects. When any of these drugs are used with a sulfonylurea there is a risk of hypoglycemia. They have no influence on the weight.
Gliflozins (or SGLT2 inhibitors)
In Belgium, the available gliflozins are
- Canagliflozin under the brand name Invokana®
- Dapagliflozin under the brand name Forxiga®
- Empagliflozin under the brand Jardiance®
These gliflozins may reduce cardiovascular risk in some patients at high cardiovascular risk, and protect the kidney in patients with already damaged kidneys. But they work less well when the kidneys work less well.
Side effects include hypoglycaemia when this treatment is taken with certain other diabetes medicines, frequent urination, pain when passing urine, urinary tract infections and genital fungal infections (candidiasis).
GLP-1 analogues (or incretinomimetics)
In Belgium, the GLP-1 analogues available are
- Dulaglutide under the brand name Trulicity®
- Exeatide under the brands Bydureon® and Byetta®
- Liraglutide under the brand Victoza®
- Lixisenatide under the brand Lyxumia®
- Semaglutide under the brand Ozempic®
- Action on micro and macro complications
- Side effects
- Dose and taken in relation to the meal
They are given by injection into adipose tissue (body fat) under the skin (subcutaneous injection). Some drugs in this group lower cardiovascular risk, especially in people who already have cardiovascular problems. These drugs can cause weight loss.
Side effects include reactions at the injection site, hypoglycaemia when this treatment is taken with certain other diabetes medicines and nausea.
Want to know more?
- Metformin – CBIP – Belgian Center for Pharmacotherapeutic Information
- Hypoglycemic sulfonylureas – CBIP – Belgian Center for Pharmacotherapeutic Information
- Glinides – CBIP – Belgian Center for Pharmacotherapeutic Information
- Glitazones – CBIP – Belgian Center for Pharmacotherapeutic Information
- Gliptins – CBIP – Belgian Center for Pharmacotherapeutic Information
- Gliflozins – CBIP – Belgian Center for Pharmacotherapeutic Information
- GLP-1 analogues – CBIP – Belgian Center for Pharmacotherapeutic Information
Sources
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