Typically, oral agents for diabetes management are prescribed to people with type 2 diabetes when diet and exercise alone are not enough to manage blood glucose levels. They can be combined with two or more medications or used as a treatment alone. For people with more advanced diabetes, they are sometimes combined with insulin therapy.
Women with gestational diabetes may also need to take oral agents, such as metformin, if dietary changes and exercise are not enough to keep their blood glucose levels within range.
How oral agents work
Oral agents increase insulin secretion from the pancreas and improve insulin sensitivity. Often the first-line treatment for type 2 diabetes, they are easy to take, help control blood glucose levels and reduce the risk of diabetes complications. Choosing the right oral agent depends on several factors, including the severity of diabetes, the intended use and other medical conditions.
Several classes of oral agents are available, so working with a healthcare professional is important when choosing the right oral glucose-lowering agent for type 2 diabetes management.
Unfortunately, not all oral agents are suitable for all people with diabetes, and healthcare professionals need to customise the treatment according to their patients’ needs. Knowing the facts can help when choosing an oral agent for a patient’s treatment plan.
Types of oral agents
There are five types of non-insulin oral agents used to treat type 2 diabetes:
- Metformin (biguanides): Reduces glucose production from the liver
- Thiazolidinediones (glitazones): Enhance glucose removal from the bloodstream.
- Insulin-releasing pills (sulfonylureas/secretagogues): Increases insulin release from the pancreas
- Starch blockers (alpha-glucosidase inhibitors): Slow starch (sugar) absorption from the gut.
- Incretin-based therapies (euglycemics ): Reduce sugar production in the liver and slow the absorption of food.
Considering potential side effects
Potential side effects should also be considered when developing an oral agent treatment plan. Sulfonylureas, for example, may cause hypoglycaemia (low blood glucose) in some people with diabetes and may not be suitable for those with kidney or liver disease. Biguanides, on the other hand, may cause gastrointestinal side effects, such as diarrhoea and nausea.
Another factor is how oral agents interact with diabetes complications to prioritise management and reduce risks. This can be done by testing blood glucose levels several times daily or using a continuous glucose monitoring device to track levels over time.
In addition to monitoring blood glucose levels, several other considerations must be made when taking oral agents for the best possible outcomes. These may include following a healthy diet, exercising regularly, and managing other medical conditions, such as high blood pressure and cholesterol.
Related resources
Online course
Type 2 diabetes - Oral agents fact-checking
A free IDF School of Diabetes online course for healthcare professionals that provides a customised set of modules on the management of type 2 diabetes using oral glucose-lowering agents.
link to https://www.idfdiabeteschool.org/premium-courses/t2dm-oral-agents-fact-checking
Guideline
IDF Clinical Practice Recommendations for Managing Type 2 Diabetes in Primary Care
Published in 2017, these Clinical Practice Recommendations for healthcare professionals summarise current evidence around optimal management of people with type 2 diabetes.
T2D-primary-care.pdf
pdf
3MB
