Endocrine

Medicines for Type 2 diabetes

A long-term condition where blood glucose runs too high because the body does not respond to insulin properly — managed with lifestyle, several classes of glucose-lowering medicine, and attention to heart and kidney risk.

Education and reference only. This explains which medicines are used and why, in plain language — it deliberately contains no doses and is not a substitute for advice from your doctor or pharmacist. Always discuss your own treatment with a qualified clinician, and check the BNF and the product labelling for prescribing detail.

Written by Meds Global Health Clinical Team · Clinically reviewed by Dr Muhammad Suffyan, MB BS, Founder & Clinical Director · Last reviewed · How we review

Quick answer

What is Type 2 diabetes?

Type 2 diabetes develops when the body becomes resistant to its own insulin and, over time, cannot make enough to keep blood glucose in range. It is strongly linked to weight, activity and genetics, and often develops gradually, so it may be picked up on a blood test before symptoms appear.

  • How it is treated: Management starts with education, diet and activity, and a clear picture of the person's overall risk.
  • Self-care: Weight loss where appropriate, a healthier eating pattern, regular activity and stopping smoking can substantially improve glucose control — and significant weight loss can, in some people, push early type 2 diabetes into remission.
  • When to seek help: Very high glucose with thirst, drowsiness, vomiting or rapid breathing, or any symptoms of low glucose that do not respond to treatment, need urgent help.

What it is

Type 2 diabetes develops when the body becomes resistant to its own insulin and, over time, cannot make enough to keep blood glucose in range. It is strongly linked to weight, activity and genetics, and often develops gradually, so it may be picked up on a blood test before symptoms appear. Persistently high glucose damages blood vessels and nerves, which is why diabetes care is about far more than the glucose number alone: it also targets blood pressure, cholesterol, the kidneys, the eyes and the feet to prevent long-term complications.

How it is treated

Management starts with education, diet and activity, and a clear picture of the person's overall risk. Metformin is usually the first medicine. What is added next is increasingly guided not just by glucose control but by whether the person has heart disease, heart failure or kidney disease — because some newer classes protect the heart and kidneys independently of their glucose effect. Treatment is individualised, reviewed with HbA1c (a measure of average glucose over time), and combined with management of blood pressure and cholesterol.

For this condition, these medicines

Medicine classes used for Type 2 diabetes

Each links to a full, dose-free guide — what it is, how it works, who can and cannot use it, side effects, interactions and FAQs.

Metformin Endocrine / Diabetes The usual first-line medicine; improves insulin sensitivity and does not itself cause low glucose. SGLT2 inhibitors Endocrine / Cardiovascular Increasingly used early for their proven heart- and kidney-protective benefits, not just glucose lowering. GLP-1 receptor agonists Endocrine / Diabetes Lower glucose, support weight loss and protect the heart; given by injection (some oral). DPP-4 inhibitors Endocrine / Diabetes Well-tolerated oral add-on with a low risk of low glucose. Sulfonylureas Endocrine / Diabetes Long-established, effective oral option; can cause low glucose and weight gain. Pioglitazone Endocrine / Diabetes Improves insulin sensitivity; used in selected people with specific cautions. Insulin Endocrine / Diabetes Added when other agents no longer keep glucose in range, or earlier if glucose is very high.

Symptom checker

Symptoms that can point to Type 2 diabetes

Type 2 diabetes can be one cause of these symptoms. Each guide explains the other possible causes and the red-flag warning signs that mean you should get urgent help:

FatigueA persistent lack of energy or overwhelming tiredness that is not relieved by rest and int…Unintentional weight lossLosing weight without trying should always be assessed by a doctor, as it can be caused by…Frequent urinationNeeding to pass urine more often than usual, by day or night, which can be due to a bladde…Erectile problemsErectile problems mean difficulty getting or keeping an erection firm enough for sex, whic…Excessive thirstA persistent, abnormal thirst that is not satisfied by drinking — which can simply follow …Dry mouthA persistent feeling that the mouth is dry and short of saliva — often a side effect of me…Bleeding gumsGums that bleed when you brush, floss or eat — usually a sign of gum inflammation from pla…Excessive hungerA persistent or unusually strong urge to eat that is out of keeping with your normal appet…Frequent infectionsCatching infections more often than expected, or finding they are more severe, slow to cle…Persistent bad breathAn unpleasant smell from the mouth that does not clear with brushing — most often caused b…Dry, flaky skinSkin that feels rough, tight, flaky or scaly because it is short of moisture — usually dow…Leg ulcers and slow-healing woundsOpen sores on the lower leg or foot, or wounds that are slow to heal, usually caused by po…Dizziness when standing upLightheadedness, wooziness or near-fainting that comes on when you stand up, caused by a b…

Clinical formulas & tools

Calculators used in Type 2 diabetes

Risk scores and formulas that inform assessment and treatment decisions in this condition:

HbA1c to Average GlucoseEstimated average glucose from HbA1c.HOMA-IREstimate of insulin resistance.eGFR (CKD-EPI 2021)Estimated GFR, race-free creatinine equation.Body Mass Index (BMI)Weight-for-height screening measure.

By active ingredient

Specific medicines used for Type 2 diabetes

Dose-free guides to individual active ingredients used in type 2 diabetes — what each is, how it works, how to take it, and its advantages and disadvantages:

GliclazideA sulfonylurea tablet that lowers blood sugar in type 2 diabetes by prompting the pancreas…DapagliflozinAn SGLT2 inhibitor that lowers blood sugar by removing glucose in the urine, and also prot…EmpagliflozinAn SGLT2 inhibitor that lowers blood sugar through the kidneys and protects the heart and …SitagliptinA once-daily tablet for type 2 diabetes that gently lowers blood sugar with little risk of…SemaglutideA GLP-1 medicine for type 2 diabetes and, separately, for weight management — usually a we…LinagliptinA once-daily tablet for type 2 diabetes that gently lowers blood sugar with a low risk of …CanagliflozinA once-daily type 2 diabetes tablet that lowers blood sugar by removing glucose in the uri…LiraglutideA once-daily injection that lowers blood sugar and reduces appetite, used for type 2 diabe…DulaglutideA once-weekly injection for type 2 diabetes that lowers blood sugar, supports weight loss …TirzepatideA once-weekly injection for type 2 diabetes that lowers blood sugar and helps with weight.…ExenatideAn injectable GLP-1 medicine for type 2 diabetes that lowers blood sugar and curbs appetit…AlogliptinA once-daily tablet for type 2 diabetes that gently lowers blood sugar with a low hypo ris…ErtugliflozinA once-daily tablet for type 2 diabetes that lowers blood sugar by removing glucose in the…GlimepirideA once-daily sulfonylurea that lowers blood sugar in type 2 diabetes by prompting the panc…GlipizideA sulfonylurea that lowers blood sugar in type 2 diabetes by prompting the pancreas to rel…VildagliptinA DPP-4 inhibitor (gliptin) that gently lowers blood sugar in type 2 diabetes with a low r…SaxagliptinA once-daily DPP-4 inhibitor (gliptin) that gently lowers blood sugar in type 2 diabetes w…TolbutamideAn older, short-acting sulfonylurea taken with meals to lower blood sugar in type 2 diabet…Insulin glargineA long-acting (basal) insulin that gives steady background insulin cover, usually injected…Insulin aspartA rapid-acting (mealtime) insulin injected around eating to cover the rise in blood glucos…Insulin lisproA rapid-acting (mealtime) insulin injected around eating to cover the rise in blood glucos…Insulin detemirA long-acting (basal) insulin that gives background insulin cover, often taken once or twi…Insulin degludecAn ultra-long-acting (basal) insulin giving very steady background cover, taken once a day…Isophane insulinAn intermediate-acting (NPH) insulin used for background cover, with a noticeable peak in …AcarboseA type 2 diabetes tablet taken with meals that slows the digestion of carbohydrate to redu…RepaglinideA short-acting tablet that lowers blood sugar after meals in type 2 diabetes, taken before…NateglinideA short-acting tablet that controls blood sugar after meals in type 2 diabetes, taken befo…GlibenclamideA long-acting diabetes tablet that lowers blood sugar by prompting the pancreas to make mo…AcetohexamideAn older sulfonylurea tablet that lowers blood sugar in type 2 diabetes, now largely repla…ChlorpropamideAn old, very long-acting diabetes tablet that lowers blood sugar; now largely obsolete.…MiglitolA type 2 diabetes medicine that slows carbohydrate digestion, taken with the first bite of…OrforglipronA newer once-daily tablet from the GLP-1 group, used for type 2 diabetes and weight manage…TolazamideAn older first-generation sulfonylurea once used for type 2 diabetes, now largely obsolete…BexagliflozinAn SGLT2 inhibitor that lowers blood sugar in type 2 diabetes by removing excess glucose i…Insulin icodecA long-acting insulin injected once a week to provide steady background blood-sugar contro…SotagliflozinA medicine that blocks two sugar-handling transporters, used in heart failure and in diabe…Insulin glulisineA fast-acting mealtime insulin that lowers the rise in blood sugar after eating, used in t…LixisenatideAn injectable medicine that helps lower blood sugar in type 2 diabetes, working with the b…MetforminThe usual first-choice tablet for type 2 diabetes — it lowers blood sugar without causing …PioglitazoneA type 2 diabetes tablet that improves the body’s response to its own insulin — effective …

Beyond medication

Lifestyle and self-care

Weight loss where appropriate, a healthier eating pattern, regular activity and stopping smoking can substantially improve glucose control — and significant weight loss can, in some people, push early type 2 diabetes into remission.

When to get help

When to see a doctor

Very high glucose with thirst, drowsiness, vomiting or rapid breathing, or any symptoms of low glucose that do not respond to treatment, need urgent help. Routine glucose questions should be discussed with your diabetes team, GP or pharmacist.

999Emergency — call 999 or go to A&E
111Urgent advice — call NHS 111 or use 111 online
GPNon-urgent — see your GP or pharmacist

Not sure how urgent it is? It is always OK to call NHS 111 for advice, day or night.

Answers

Type 2 diabetes: frequently asked questions

What medicines treat type 2 diabetes?

Metformin is usually first. Other classes include SGLT2 inhibitors, GLP-1 receptor agonists, DPP-4 inhibitors, sulfonylureas, pioglitazone and, when needed, insulin. The choice increasingly depends on your heart and kidney health as well as your glucose levels.

Which diabetes medicines protect the heart and kidneys?

SGLT2 inhibitors and certain GLP-1 receptor agonists have been shown to reduce cardiovascular and kidney complications beyond their glucose-lowering effect, which is why they are often chosen early in people at risk.

Can type 2 diabetes be reversed?

Early type 2 diabetes can go into remission in some people, particularly with substantial, sustained weight loss. This should be pursued with medical support, as medication and monitoring may need to change.

Will I need insulin?

Not necessarily. Many people manage with tablets and/or non-insulin injections for years. Insulin is added when these no longer keep glucose in target, or sooner if glucose is very high at diagnosis.

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Sources

Where this is drawn from

  • NICE NG28: Type 2 diabetes in adults: management.
  • NICE CKS: Type 2 diabetes.

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