title: Glucose-lowering medicines for type 2 diabetes.
abstract: BACKGROUND
  There is an increasing array of medicines available to improve blood glucose control in type 2 diabetes. Finding the best combination for an individual patient requires an assessment of the patient's characteristics and understanding the mechanism of action for each drug.
  
  
  OBJECTIVE
  The aim of this article is to provide a rational approach for choosing between the various blood glucose-lowering medicines available for treatment of patients with type 2 diabetes mellitus.
  
  
  CONCLUSIONS
  Metformin is the first choice of glucose-lowering medicines for most patients with type 2 diabetes. Sulphonylureas have proven benefits in long-term trials. Insulin is required in patients with symptoms of insulin deficiency. Glucagon-like peptide 1 agonists and sodium-glucose co-transporter 2 inhibitors provide some assistance in weight loss as well as improving blood glucose control. Dipeptidyl peptidase 4 inhibitors provide an alternative to metformin and sulphonylureas, especially when side effects of those drugs limit their use. Re-assessing blood glucose control after an appropriate trial period before deciding on continuing use is appropriate.
authors.affiliation: BMed, MD, FRACP, Director, Diabetes and Endocrinology, Gold Coast University Hospital, and Associate Professor, Griffith University School of Medicine, Southport, QLD.
authors.forename: Peter
authors.initials: P
authors.lastname: Davoren
mesh_terms: D020909:Acarbose / Q000627:therapeutic use; D001786:Blood Glucose / Q000378:metabolism; D003924:Diabetes Mellitus, Type 2 / Q000097:blood / Q000188:drug therapy*; D054873:Dipeptidyl-Peptidase IV Inhibitors / Q000627:therapeutic use; D004359:Drug Therapy, Combination; D005260:Female; D006442:Glycated Hemoglobin / Q000378:metabolism; D006801:Humans; D007004:Hypoglycemic Agents / Q000627:therapeutic use*; D007328:Insulin / Q000627:therapeutic use; D008297:Male; D008687:Metformin / Q000627:therapeutic use; D008875:Middle Aged; D051269:Sodium-Glucose Transporter 1 / Q000037:antagonists & inhibitors; D013453:Sulfonylurea Compounds / Q000627:therapeutic use; D045162:Thiazolidinediones / Q000627:therapeutic use; D000097789:Glucagon-Like Peptide-1 Receptor Agonists
chemical_list: D020909:Acarbose; D001786:Blood Glucose; D054873:Dipeptidyl-Peptidase IV Inhibitors; D006442:Glycated Hemoglobin; D007004:Hypoglycemic Agents; D007328:Insulin; D008687:Metformin; D051269:Sodium-Glucose Transporter 1; D013453:Sulfonylurea Compounds; D045162:Thiazolidinediones; D000097789:Glucagon-Like Peptide-1 Receptor Agonists; C495674:SLC5A1 protein, human