Comparing Diabetes Drugs and Treatments

For details on specific drugs and treatments for diabetes, refer to the following articles:

• Antidiabetic Drugs
• Treatments for Type 2 Diabetes

Comparing Diabetes Pills

Fast Facts:

• Different kinds of diabetes pills work in different ways to control blood sugar (blood glucose).
• Combining two different kinds of diabetes pills can work better to lower your blood sugar than a single medicine.
• But combining two kinds of diabetes pills can make it more likely that your blood sugar will drop too low.
• Most diabetes pills can cause weight gain. One kind, metformin (Glucophage®), does not make you gain weight.
• Diabetes pills won't raise or lower your blood pressure enough to affect your health.

Weight Gain

These pills can make you gain weight:

• glimepiride (Amaryl®)
• glipizide (Glucotrol®)
• glyburide (Diabeta®, Glynase PresTab®, Micronase®)
• pioglitazone (Actos®)
• rosiglitazone (Avandia®)
• repaglinide (Prandin®)

The weight gain is around 2 to 10 pounds.

Metformin (Glucophage®) does not make you gain weight.

We don't know about weight changes with acarbose (Precose®), miglitol (Glyset®), and nateglinide (Starlix®) because there isn't as much research on these three drugs.

Stomach Problems

Metformin (Glucophage®) is more likely than other diabetes pills to cause diarrhea, stomach cramps, and gas. Let your doctor or nurse know if you get any of these problems.

Swelling

Pioglitazone (Actos®) and rosiglitazone (Avandia®) are more likely to cause water retention than other diabetes pills. If you get swelling in your face or legs, it might be from water retention. Tell your doctor or nurse.

Cholesterol

There are different kinds of cholesterol. They are often called “bad” and “good.” Low bad cholesterol and high good cholesterol mean a healthier heart and arteries. Talk to your doctor or nurse about ways to reach the right targets for you.

Diabetes pills are mainly for lowering blood sugar. But research shows a few of the diabetes pills can affect cholesterol.

Bad Cholesterol (LDL)

Everyone should try to keep bad cholesterol (LDL cholesterol) as low as possible. Bad cholesterol can clog your arteries. This makes it harder for the blood to flow. Clogged arteries can cause heart attacks and stroke. People with diabetes can have more problems, like heart attacks, when their bad cholesterol is high.

Metformin (Glucophage®) can lower bad cholesterol about 10 points compared with:

• glimepiride (Amaryl®)
• glipizide (Glucotrol®)
• glyburide (Diabeta®, Glynase PresTab®, Micronase®)

This means that if your bad cholesterol is 120, metformin might lower it to 110.

Rosiglitazone (Avandia®) and pioglitazone (Actos®) can raise bad cholesterol. Rosiglitazone (Avandia®) raises bad cholesterol by 10 points more than pioglitazone (Actos®).

Good Cholesterol (HDL)

Good cholesterol (HDL cholesterol) helps remove extra cholesterol from the body. When your good cholesterol is higher, your chance of heart disease is lower.

Most diabetes pills do not raise or lower good cholesterol enough to affect your health.

Comparing Other Drugs and Treatments

Research studies have compared newer premixed insulin with other diabetes medicines. This research can help you and your doctor decide whether newer premixed insulin might be a good choice for you. In these charts, a checkmark means research shows the medicine works better than the medicine it is compared with.

Comparing newer premixed insulin and pills for diabetes

Newer premixed insulin can lower blood sugar more than pills for diabetes. Newer premixed insulin is more likely to cause very low blood sugar. It can also cause more weight gain than diabetes pills.

Comparing newer premixed insulin and long-acting insulin

Newer premixed insulin can lower A1c and blood sugar after meals more than long-acting insulin. But long-acting insulin is better at lowering blood sugar before eating. Newer premixed insulin is more likely to cause very low blood sugar. It can also cause more weight gain than long-acting insulin.

Comparing newer premixed insulin and premixed NPH/regular insulin

The different types of premixed insulin work about the same. Newer premixed insulin is better at lowering blood sugar after meals.