What are the top 4 commonly prescribed T2DM drugs?

[TytoAlba95]

Hi. I'm planning research on Diabetes(T2DM) and for that, I'm looking for the top 4 antidiabetic medicines.

[Moderator Note -- OP has edited their post and thread title to clarify which type of diabetes the question applies to]

I've thoroughly googled but couldn't find any authentic article (written by Doctors and not health journalist) or one that is recent and clearly states 'in order of most prescribed'.
I'm aware that metformin is the drug that is mostly prescribed. It is the doctor's first choice for all age groups (source, yes, I also Pubmeded). My aim at creating this post is to get experts' comments (maybe a doctor's or someone working in this field will be great!) on whether the following drugs are roughly the most prescribed drugs for diabetes. I'm aware that prescription varies with comorbidities and age group.

1. Metformin
2. Sulfonylurea
3. Meglitinide
4. Thiazolidinediones (Source: Mayoclinic)

 

[jim mcnamara]

Is there a reason you did not include insulin and analogs -- e.g. Humulin? Plus, I'm sure you know that there is type I diabetes, which basically involves the absence or loss function of the Islets of Langerhans in the pancreas.
Type II diabetes is what you are focused on. Long acting insulin, like Ultralente, is very often prescribed as an adjunct in Type II, usually at the onset of mild type II as the result of low serum insulin levels.

Clinical discussion for new patients:
https://www.webmd.com/diabetes/type-two-diabetes-insulin-therapy

 

[berkeman]

Hi. I'm planning research on Diabetes and for that, I'm looking for the top 4 antidiabetic medicines.
I've thoroughly googled but couldn't find any authentic article (written by Doctors and not health journalist) or one that is recent and clearly states 'in order of most prescribed'.
I'm aware that metformin is the drug that is mostly prescribed. It is the doctor's first choice for all age groups (source, yes, I also Pubmeded). My aim at creating this post is to get experts' comments (maybe a doctor's or someone working in this field will be great!) on whether the following drugs are roughly the most prescribed drugs for diabetes. I'm aware that prescription varies with comorbidities and age group.

1. Metformin
2. Sulfonylurea
3. Meglitinide
4. Thiazolidinediones (Source: Mayoclinic)

I'm assuming you mean Type 2 diabetes? And you are only asking about Rx medications, and not the other treatments (like weight loss, etc.)?

You've probably already been here:

https://www.mayoclinic.org/diseases-conditions/type-2-diabetes/diagnosis-treatment/drc-20351199

Diabetes medications and insulin therapy
Some people who have type 2 diabetes can achieve their target blood sugar levels with diet and exercise alone, but many also need diabetes medications or insulin therapy. The decision about which medications are best depends on many factors, including your blood sugar level and any other health problems you have. Your doctor might combine drugs from different classes to help you control your blood sugar in several different ways.

Examples of possible treatments for type 2 diabetes include:

• Metformin (Glucophage, Glumetza, others). Generally, metformin is the first medication prescribed for type 2 diabetes. It works by lowering glucose production in the liver and improving your body's sensitivity to insulin so that your body uses insulin more effectively.
  
  Nausea and diarrhea are possible side effects of metformin. These side effects may go away as your body gets used to the medicine or if you take the medicine with a meal. If metformin and lifestyles changes aren't enough to control your blood sugar level, other oral or injected medications can be added.
• Sulfonylureas. These medications help your body secrete more insulin. Examples include glyburide (DiaBeta, Glynase), glipizide (Glucotrol) and glimepiride (Amaryl). Possible side effects include low blood sugar and weight gain.
• Meglitinides. These medications — such as repaglinide (Prandin) and nateglinide (Starlix) — work like sulfonylureas by stimulating the pancreas to secrete more insulin, but they're faster acting, and the duration of their effect in the body is shorter. They also have a risk of causing low blood sugar and weight gain.
• Thiazolidinediones. Like metformin, these medications — including rosiglitazone (Avandia) and pioglitazone (Actos) — make the body's tissues more sensitive to insulin. These drugs have been linked to weight gain and other more-serious side effects, such as an increased risk of heart failure and anemia. Because of these risks, these medications generally aren't first-choice treatments.
• DPP-4 inhibitors. These medications — sitagliptin (Januvia), saxagliptin (Onglyza) and linagliptin (Tradjenta) — help reduce blood sugar levels, but tend to have a very modest effect. They don't cause weight gain, but may cause joint pain and increase your risk of pancreatitis.
• GLP-1 receptor agonists. These injectable medications slow digestion and help lower blood sugar levels. Their use is often associated with weight loss. Possible side effects include nausea and an increased risk of pancreatitis.
  
  Exenatide (Byetta, Bydureon), liraglutide (Victoza) and semaglutide (Ozempic) are examples of GLP-1 receptor agonists. Recent research has shown that liraglutide and semaglutide may reduce the risk of heart attack and stroke in people at high risk of those conditions.
• SGLT2 inhibitors. These drugs prevent the kidneys from reabsorbing sugar into the blood. Instead, the sugar is excreted in the urine. Examples include canagliflozin (Invokana), dapagliflozin (Farxiga) and empagliflozin (Jardiance).
  
  Medications in this drug class may reduce the risk of heart attack and stroke in people with a high risk of those conditions. Side effects may include vaginal yeast infections, urinary tract infections, low blood pressure, and a higher risk of diabetic ketoacidosis. Canagliflozin, but not the other drugs in the class, has been associated with increased risk of lower limb amputation.
• Insulin. Some people who have type 2 diabetes need insulin therapy. In the past, insulin therapy was used as a last resort, but today it's often prescribed sooner because of its benefits. Low blood sugar (hypoglycemia) is a possible side effect of insulin.
  
  Normal digestion interferes with insulin taken by mouth, so insulin must be injected. Depending on your needs, your doctor may prescribe a mixture of insulin types to use throughout the day and night. There are many types of insulin, and they each work in a different way.
  
  Often, people with type 2 diabetes start using insulin with one long-acting shot at night, such as insulin glargine (Lantus) or insulin detemir (Levemir). Discuss the pros and cons of different drugs with your doctor. Together you can decide which medication is best for you after considering many factors, including costs and other aspects of your health.

In addition to diabetes medications, your doctor might prescribe low-dose aspirin therapy as well as blood pressure and cholesterol-lowering medications to help prevent heart and blood vessel disease.

 

[TytoAlba95]

Is there a reason you did not include insulin and analogs -- e.g. Humulin? Plus, I'm sure you know that there is type I diabetes, which basically involves the absence or loss function of the Islets of Langerhans in the pancreas.
Type II diabetes is what you are focused on. Long acting insulin, like Ultralente, is very often prescribed as an adjunct in Type II, usually at the onset of mild type II as the result of low serum insulin levels.

Clinical discussion for new patients:
https://www.webmd.com/diabetes/type-two-diabetes-insulin-therapy

Thanks for pointing out, I should have included T2DM in my question. Yeah, I'm completely aware of the types of DM. I'm avoiding insulin and sticking to chemical drugs because of certain constraints.

 

[TytoAlba95]

Thanks, but my top 4 is from your list.

" And you are only asking about Rx medications, and not the other treatments (like weight loss, etc.)? "
Sorry I didn't get you. Are you asking whether I'm interested in problems that are implicated to Diabetes?

 

[Ygggdrasil]

Here's a scientific paper listing the top 200 prescribed drugs in the US. By looking through for antidiabetic medications, you could get the top 4 prescribed anti-diabetic medications: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6025009/

 

[DaveC426913]

I'm on Metformin as well as Dulaglutide (Trulicity).

 

[berkeman]

" And you are only asking about Rx medications, and not the other treatments (like weight loss, etc.)? "
Sorry I didn't get you. Are you asking whether I'm interested in problems that are implicated to Diabetes?

I'm not able to parse your reply, but I guess I'm asking if you are interested in what most doctors are recommending to their Type 2 diabetic patients. They don't only write Rx, they often will propose other Tx besides drugs (like exercise and diet). What is the scope of your paper?

 

[jim mcnamara]

Usually, first time diabetics in the US get diet training, this is true in Europe as well. Type II is thought of as inflammatory disease, where dietary components that make up the so-called Western Diet are suggested as things to avoid. Exercise is prescribed often. Diet and lifestyle.

Type II is typically preceded by a diagnosis of Metabolic Syndrome.
https://www.mayoclinic.org/diseases-conditions/metabolic-syndrome/symptoms-causes/syc-20351916

 

[TytoAlba95]

Thank you everyone for responding to this thread.

@Ygggdrasil Thank you, for such a big help! I didn't think I could really find a scientific paper on top prescribed drugs and was mostly Googling.

@DaveC426913 Thanks for sharing that you are on Dulaglutide. I thought Sulfonylurea and Glitazones are next in line after Metformin, but GLP-1 agonists are prescribed too...that's interesting.

@jim mcnamara Thanks for writing back, I have just started reading about Metabolic syndrome. I think you confused Type 1 with Type 2. Type I is an autoimmune disorder, the aetiology of T2DM is not clearly known.

@berkeman I was initially not sure as what you were saying, but now that you mention Tx I got you.
I'm planning research to look into the molecular aspects of the diabetic drug(s), not aiming to improve them. So I'm looking for the top meds for my work. I'm just at the preliminary stage... and yet to plan the whole research.
Thanks for replying. :)

 

[DaveC426913]

Thanks for sharing that you are on Dulaglutide. I thought Sulfonylurea and Glitazones are next in line after Metformin, but GLP-1 agonists are prescribed too...that's interesting.

Doc was going to Rx something else, but when she told me this one was a once-a-week self-injection, I jumped at the chance. Way better than daily pills for me.