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Treatments for Type 2 Diabetes

Updated on September 08, 2022
Medically reviewed by
Robert Hurd, M.D.
Article written by
Kelly Crumrin
Article written by
Jane Chung, PharmD, RPh

Although type 2 diabetes cannot be cured, there are effective treatments that have been proven in clinical studies to help control blood glucose levels. These treatments slow the progression of the disease and prevent serious complications.

In some cases, early-stage diabetes can be reversed — put into remission — with treatment. Guidelines for type 2 diabetes treatments and medications are based on how high your blood glucose is, how well it is controlled, your age and overall health, any other health conditions, and medications you take.

Studies have found that many people with type 2 diabetes do not take their medications regularly or as directed, and at least 45 percent of those with type 2 diabetes do not get their blood glucose under control.

Stopping or underusing a medication allows blood sugar to rise, causing progressive damage that leads to worsening symptoms and complications of diabetes, such as blindness, kidney damage, and foot amputation. Untreated hyperglycemia (high blood sugar) can also lead to an increased risk for heart attack, stroke, and cardiovascular disease (disease of the heart and blood vessels).

Continue taking all medications as prescribed even if you feel better. If side effects bother you, talk to your doctor about switching medications or timing them differently. Set reminders and ask for help from family if you have trouble remembering to take your type 2 diabetes treatments.

Types of Treatments for Type 2 Diabetes

Lifestyle changes, including losing weight, eating healthier, and getting more exercise, are considered first-line therapy for type 2 diabetes. These changes can have a significant impact on how fast insulin resistance progresses.

Medications can help control blood sugar levels. Type 2 diabetes is a progressive disease, and at some point, you will likely need to begin using insulin to control your blood glucose levels.

Many people with type 2 diabetes are prescribed multiple medications that work together to better control blood glucose levels. For more details about specific diabetes treatments, visit the Treatments A-Z page.

Monitoring

Testing and tracking your blood glucose is a vital part of managing your type 2 diabetes. Regularly monitoring your blood sugar at home helps you better control your glucose levels and gives your doctor a clear picture of how well your medication is working.

If you are taking your medications as directed, and your blood glucose is not under control, your doctor will be able to change the timing or dosage of medicine to be more effective. You may also be a candidate for newer forms of measuring your glucose, including continuous glucose monitoring.

Lifestyle Changes

Improving diet and increasing exercise are fundamental to the successful treatment of type 2 diabetes.

Some people with type 2 diabetes can get their blood glucose under control with significant weight loss, changing eating habits, and increasing physical activity, without adding medications.

Weight loss can lower levels of inflammation in the body that are believed to contribute to insulin resistance.

Exercise makes the body more sensitive to insulin, lowers blood glucose levels, and also contributes to weight loss.

Eating a lower-calorie diet can help with weight loss. Changing the amount and type of carbohydrates you eat can help you maintain healthy blood glucose levels, and eating fewer saturated fats can help control cholesterol and triglyceride levels.

Learn more about healthy snack ideas for diabetes.

The DiRECT trial, reported in The Lancet, found that consuming a low-calorie diet led to the remission of type 2 diabetes. This means that blood sugar levels returned to normal without needing diabetes medication. Although this diet is not realistic for everyone, healthy eating and being mindful of your body weight can certainly help manage diabetes.

Medications

There are more than 10 classes of medications approved for treating type 2 diabetes. Most are taken by mouth, and others are injected.

Some diabetes medications need to be taken at a certain time of day, such as before meals or with the first bite of a meal, to be effective. Ask your doctor or pharmacist about when to take your diabetes medications if you are not sure.

Some diabetes medications can cause upset stomach and hypoglycemia (low blood sugar) as common side effects. Other side effects are specific to each drug or drug class. The most common classes of drugs prescribed for type 2 diabetes are highlighted below.

Biguanides

Metformin is the only drug available in the class called biguanides, which are believed to work by decreasing the amount of glucose produced by the liver and making the muscle tissue more sensitive to insulin.

Metformin is considered a first-line treatment for high blood glucose in people with type 2 diabetes, along with diet and exercise. It is also the only drug recommended by the American Diabetes Association for the prevention of type 2 diabetes in adults with prediabetes.

Metformin is sold under brand names including Fortamet, Glumetza, Glucophage, and Riomet.

If your blood glucose is not controlled with lifestyle changes and metformin, guidelines recommend adding another medication or insulin. If this combination does not work to control blood glucose, the doctor will likely prescribe additional medications.

Sulfonylureas

Sulfonylureas work by increasing the amount of insulin released by the pancreas. Sulfonylureas include glyburide (DiaBeta and Micronase) and glimepiride (Amaryl).

Thiazolidinediones

Thiazolidinediones, also known as TZDs and glitazones, are believed to work by decreasing the amount of glucose released by the liver and making insulin more effective in muscle and fat tissues. Glitazones include pioglitazone (Actos) and rosiglitazone (Avandia).

GLP-1 Receptor Agonists

Glucagon-like peptide-1 (GLP-1) receptor agonists, also called incretin mimetics, are another class of medications.

GLP-1 is a hormone that signals the pancreas to make more insulin and prevents the liver from releasing glucose. GLP-1 receptor agonists are believed to work by improving the ability of the pancreas to secrete insulin in response to meals, thus normalizing blood glucose levels. These drugs also cause weight loss.

Liraglutide (Victoza), dulaglutide (Trulicity), exenatide (Byetta and Bydureon), and semaglutide (Ozempic and Rybelsus) are GLP-1 receptor agonists.

DPP-4 Inhibitors

Dipeptidyl peptidase 4 (DPP-4) inhibitors — such as linagliptin (Tradjenta), sitagliptin (Januvia), and saxagliptin (Onglyza) — work by blocking the protein DPP-4 from breaking down GLP-1 that the body makes. This process allows naturally occurring GLP-1 to stay active in the body for a longer amount of time.

SGLT2 Inhibitors

Drugs in the sodium-glucose transporter 2 (SGLT2) inhibitor class work by causing extra glucose to be eliminated in the urine. Dapagliflozin (Farxiga), canagliflozin (Invokana), and empagliflozin (Jardiance) are SLGT2 inhibitors.

GIP/GLP-1 Receptor Agonists

In May 2022, the U.S. Food and Drug Administration approved a new medication for type 2 diabetes called tirzepatide (sold as Mounjaro). Tirzepatide is the first approved medication in this new class of GIP/GLP-1 receptor agonists. Tirzepatide works by activating both GLP-1 receptors (similar to exenatide) and glucose-dependent insulinotropic polypeptide (GIP) receptors. GIP is a hormone similar to GLP-1 — they both control blood sugar.

Combination Medications

Some people with a complex treatment regimen for type 2 diabetes may prefer to take a combination drug that has medications from more than one class. Taking one medication instead of several may be more convenient and easier to remember.

Examples of combination drugs include pioglitazone/metformin (Actoplus Met), glyburide/metformin (Glucovance), sitagliptin/metformin (Janumet), and empagliflozin/metformin (Synjardy).

Insulin

If medication, improvements in diet, and exercise fail to keep blood glucose levels in check, your doctor will likely suggest that you begin insulin therapy.

Type 2 diabetes is a progressive disease — the longer you have it, the more likely you are to need insulin, even if you make lifestyle changes and stick to your treatment plan. Insulin is just another way to control blood glucose.

When your doctor prescribes insulin, they will help you calculate the dosage and explain how to schedule your insulin doses. After you have used insulin for a while, your doctor will help you adjust the dosage for maximum effectiveness.

There are several types of insulin:

  • Rapid-acting — Taken before a meal and effective in about 15 minutes for one to two hours
  • Regular or short-acting — Taken before a meal and effective in about 30 minutes for three to six hours
  • Intermediate-acting — Taken twice a day and effective for 12 to 18 hours
  • Long-acting — Taken once a day and effective for up to 24 hours
  • Ultra long-acting — Taken once a day and effective for about 36 hours or longer
  • Premixed — Combines shorter-acting insulin with longer-acting insulin

Insulin is sold under many brand names. Examples include:

Injectable insulin must be injected subcutaneously (into the fat under the skin) — it is not effective if it is swallowed. Insulin injection areas include fleshy parts of the abdomen, thighs, buttocks, and the backs of the arms. Insulin is absorbed most quickly when injected into the abdomen.

Afrezza, the only inhaled insulin product on the market, was made available in the U.S. in 2015.

There are several delivery methods for injectable insulin.

Syringes

There are many types of syringes. Your doctor can help you to choose the brand that is right for you. The barrel (the part that holds the liquid) must be large enough to hold a dose. The markings on the barrel must be legible for you. The needle gauge is another factor. The higher the number the needle gauge is, the smaller the needle will be. Some people find that smaller needles cause less pain.

Pens

Insulin pens are small, lightweight devices that resemble large ink pens. Most insulin pens have removable needles that should be replaced for each use. Insulin pens may be disposable or durable (refillable). Disposable pens come prefilled with insulin, and durable pens must be filled with insulin cartridges. Insulin pens may be easier to use while traveling because they can be kept at room temperature for several days.

Pump

An insulin pump consists of a small computerized device (the pump) approximately the size of a cell phone, a flexible plastic tube, and a small needle. The needle is inserted into the skin of the abdomen and taped down. The tube connects the needle with the pump, which is worn on the belt or in a pocket. The pump is programmed to release insulin in two ways. Basal insulin is released continuously, and bolus insulin is released at mealtimes. This pattern imitates the body’s natural release of insulin.

Other Treatments for Type 2 Diabetes

Besides lifestyle changes and medications, some people with type 2 diabetes may need other treatments such as dialysis or surgery. Vaccinations are another important part of managing diabetes.

Dialysis

High blood glucose levels in type 2 diabetes damage the kidneys, sometimes to the point when they can no longer function well enough to keep you healthy. People with severe kidney damage require kidney replacement therapy such as dialysis. Types of dialysis include hemodialysis and peritoneal dialysis.

Hemodialysis is a process of filtering waste products from the blood using a machine as an artificial kidney, known as a dialyzer. Hemodialysis can be done at a dialysis center, in a hospital, or at home. If you receive hemodialysis at a dialysis center, you will likely need to go three times each week. Hemodialysis will take three to five hours each time you go. If you do hemodialysis at home, you may choose more frequent treatments (four to seven times each week) for shorter periods.

In peritoneal dialysis, the peritoneum (the tissue lining your abdomen) filters waste products from the blood. One advantage of peritoneal dialysis is that your body does not build up as much fluid and waste as it does with hemodialysis. There is less stress on your heart and arteries. It is also easier to maintain a normal work schedule with peritoneal dialysis because you do not need to spend hours at a dialysis center each week.

Surgeries

Some people with obesity and type 2 diabetes undergo bariatric surgery, such as gastric bypass surgery (Roux-en-Y), adjustable gastric band (also known as the lap-band or LABG), or sleeve gastrectomy, to lose weight. To be eligible for bariatric surgery, it is usually necessary to have a body mass index (BMI) over 35 or a lower BMI with medical complications such as poorly controlled diabetes.

In one study, researchers reviewed data involving more than 20,000 people with type 2 diabetes who had undergone gastric bypass surgery and found that approximately 77 percent of people completely reversed their diabetes after surgery, meaning they were able to maintain normal blood glucose levels without medication.

Amputation is sometimes a result of diabetic neuropathy (nerve damage), poor circulation, infections in people with type 2 diabetes, and poorly controlled blood glucose. Approximately 67 percent of amputations in the U.S. can be attributed to diabetes or a complication of diabetes. People with type 2 diabetes undergo amputations at a rate that is 28 times higher than people without diabetes. Most amputations involve lower extremities — for example, toe, foot, below the knee, and above the knee.

In people with end-stage kidney failure for whom dialysis is not a good option, a kidney transplant may be considered. A kidney transplant is a surgery to replace one diseased kidney with a healthy kidney from a living or deceased donor. After receiving a kidney transplant, you will need to take immunosuppressive medication for the rest of your life to prevent your body from rejecting the new organ.

Vaccinations

People with type 2 diabetes should receive appropriate vaccinations based on age and health conditions. Examples include the Tdap vaccine (to prevent tetanus, diphtheria, and pertussis), hepatitis B vaccine, and zoster vaccine (to prevent shingles).

Adults over the age of 65 are recommended to receive pneumococcal vaccines to prevent pneumonia (lung infection), meningitis (inflammation of the lung and spinal cord), and other infections caused by pneumococcal bacteria. People with type 2 diabetes should also receive the annual flu vaccine and stay up to date with their COVID-19 vaccinations.

Complementary, Alternative, and Natural Treatments

Some people with type 2 diabetes incorporate natural or holistic treatments and report relief from certain symptoms when they use complementary or alternative treatments such as acupuncture or herbal or nutritional supplements.

Acupuncture may be useful in people with diabetes experiencing pain caused by nerve damage. This traditional medicine, which has been around for thousands of years, involves inserting small needles into different parts of the body. The needles cause the brain to release chemicals that can lessen a person’s sensitivity to pain. More research is needed to determine the benefits of acupuncture, but it shows promise in treating nerve pain caused by diabetes.

Herbal or nutritional supplements such as alpha-lipoic acid, chromium, cinnamon, and ginseng are a few that have shown potential in people with type 2 diabetes.

Notify your doctor of any nutritional supplements and herbal treatments you use because some can interact with medications and cause dangerous side effects or make them less effective. Complementary therapies should not replace prescribed medications, which have been proven effective in clinical studies.

Find Your Team

On DiabetesTeam, the social network for people with type 2 diabetes and their loved ones, more than 123,000 members come together to ask questions, give advice, and share their stories with others who understand life with diabetes. Here, finding ways to manage your lifestyle while living with diabetes is a commonly discussed topic.

What treatments for diabetes have worked for you? Do you have questions for others regarding treatment? Share your experience and advice in the comments below, or start a conversation by posting on your Activities page.

References
  1. Type 2 Diabetes — Mayo Clinic
  2. Can Type 2 Diabetes Be Reversed? — Joslin Diabetes Center
  3. Poor Medication Adherence in Type 2 Diabetes: Recognizing the Scope of the Problem and Its Key Contributors — Patient Preference and Adherence
  4. Type 2 Diabetes and Insulin — Endocrine Web
  5. Monitoring Your Blood Sugar — Centers for Disease Control and Prevention
  6. Diabetes Overview — American Diabetes Association
  7. Achieving Type 2 Diabetes Remission Through Weight Loss — National Institute of Diabetes and Digestive and Kidney Diseases
  8. The Role of Inflammation in Diabetes: Current Concepts and Future Perspectives — European Cardiology Review
  9. Physical Activity/Exercise and Diabetes: A Position Statement of the American Diabetes Association — Diabetes Care
  10. Type 2 Diabetes Can Be Reversed With a Low-Calorie Diet — National Institute for Health and Care Research
  11. Primary Care-Led Weight Management for Remission of Type 2 Diabetes (Direct): An Open-Label, Cluster-Randomised Trial — The Lancet
  12. A Brief History of the Development of Diabetes Medications — Diabetes Spectrum
  13. What Are My Options? — American Diabetes Association
  14. Diabetes Medication Side Effects — Diabetes.co.uk
  15. Biguanides — Diabetes.co.uk
  16. Standards of Medical Care in Diabetes — 2022 Abridged for Primary Care Providers — Clinical Diabetes
  17. Glucagon-Like Peptide-1 Receptor Agonists — StatPearls
  18. Effects of GLP-1 on Appetite and Weight — Reviews in Endocrine & Metabolic Disorders
  19. FDA Approves Novel, Dual-Targeted Treatment for Type 2 Diabetes — U.S. Food & Drug Administration
  20. Insulin Routines — American Diabetes Association
  21. Insulin Basics — American Diabetes Association
  22. Insulin Pens — American Diabetes Association
  23. Insulin Pumps: Relief and Choice — American Diabetes Association
  24. Device Technology — American Diabetes Association
  25. Diabetes — A Major Risk Factor for Kidney Disease — National Kidney Foundation
  26. Hemodialysis — National Kidney Foundation
  27. Peritoneal Dialysis — National Kidney Foundation
  28. Bariatric (Weight-Loss) Surgery for Treating Diabetes — Cleveland Clinic
  29. Bariatric Surgery: A Systematic Review and Meta-Analysis — JAMA
  30. Amputation and Diabetes: How To Protect Your Feet — Mayo Clinic
  31. Amputations of Lower Limb in Subjects With Diabetes Mellitus: Reasons and 30-Day Mortality — Journal of Diabetes Research
  32. Diabetes and Amputation: Everything You Need To Know To Avoid Amputation — The Diabetes Council
  33. Kidney Transplant — National Kidney Foundation
  34. Flu and Pneumonia Shots — American Diabetes Association
  35. Adult Immunization Schedule — Centers for Disease Control and Prevention
  36. Complementary and Alternative Medicine Therapies for Diabetes: A Clinical Review — Clinical Diabetes
  37. Complementary and Alternative Medicine for Diabetes — University of Rochester Medical Center
All updates must be accompanied by text or a picture.
Robert Hurd, M.D. is a professor of endocrinology and health care ethics at Xavier University. Review provided by VeriMed Healthcare Network. Learn more about him here.
Kelly Crumrin is a senior editor at MyHealthTeam and leads the creation of content that educates and empowers people with chronic illnesses. Learn more about her here.
Jane Chung, PharmD, RPh earned a Bachelor of Science in Pharmacy Studies and a Doctor of Pharmacy from Northeastern University in Boston, MA. Learn more about her here.

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