Diabetes Type 2 Management – Anti-Diabetic Drugs (Sulfonylureas and Biguanides)

The prevalence of diabetes type 2 has reached epidemic proportions worldwide and it is projected to still increase dramatically. Diabetes type 2 is caused by insulin resistance (decreased responsiveness to insulin) in the body cells mainly in the liver, skeletal muscle and adipose tissue, or it can also be caused by a reduced level of insulin secretion by the pancreas, or a mixture of both.

Moreover, the prevalence of insulin resistance (poor response of body cells to insulin) which is a major causative factor in the early development of type 2 diabetes is even more widespread.

Although dietary modification and increased physical activity provide some level of control, this is often insufficient and most diabetics will still require some form of drug treatment.

Presently there are 5 different types of oral anti diabetic drugs used for treating type 2 diabetes;

a – Sulfonyureas
b – Meglitinides
c – Biguanides
d – Thiazolidinediones
e – Alpha – glucosidase inhibitors


These drugs are derived from sulfunic acid urea. They have been the cornerstone of type 2 diabetes treatment since the 1950’s

– They have proven efficacy in most patients.
– Low incidence of side effects.
– They act by directly stimulating insulin production in pancreatic B cells.
– Major side effects include hypoglycemia (over reduced and low blood sugar levels} and weight gain.
– Dosage is started from low doses.
– Examples include 1st generation drugs like chlorpropamide (diabenese}, tolbutamide, and acetohexamide.

2nd generation drugs like glyburide, glypizide and glimepiride


This drug is a synthetic analogue of guanidine

– This drug has surpassed sulfonylureas as the most prescribed oral antidiabetic drug in the US and in the European markets it is the second most prescribed antidiabetic drug after glyburide.

– It is recommended as the 1st line of treatment in newly diagnosed diabetics.
– It acts by suppressing basal hepatic glucose production (glucose production in the liver).
– It also improves whole body insulin stimulated glucose metabolism (it makes the body cells more responsive to insulin).
– It also has reduces the levels of triglycerides (fat} and free fatty acids in the body.
– Side effects include gastrointestinal disturbances like diarrhea, abdominal pain, it also causes lactic acidosis occasionally.
– It should not be taken by people with poor kidney function, and in people with liver disease.
– The most common example is metformin.