Shared Decision Making

Medicine Options to Lower My Blood Sugar Levels for Type 2 Diabetes

This decision aid is for people 18 years or older with type 2 diabetes. It is not for people who are pregnant or whose blood sugar is dangerously high. It may be less helpful for people who have been taking blood sugar medicines for a long time. Treatment options include taking one medicine alone or taking more than one medicine

About Type 2 Diabetes: Type 2 diabetes is the most common type of diabetes. It can make you pee often, feel thirsty or tired, or make cuts or bruises heal slowly. Some people have no symptoms.

Patient Questions

What does the option involve?
Metformin
You will take pills once or twice daily with food.
GLP-1 Receptor Agonist
You will take a pill once daily, or you will give yourself a shot at least weekly. This may be a good option if you have:
  • kidney problems.
  • history of heart attack or stroke.
SGLT2 Inhibitor
You will take a pill once daily.
This may be a good option if you have:
  • kidney problems.
  • history of heart attack or stroke.
  • heart failure.
DPP-4 Inhibitor
You will take a pill once daily.
Sulfonylurea
You will take a pill once daily. You may need to test your blood sugar.
Pioglitazone
You will take a pill once daily.
Insulin
You will give yourself a shot 1 to 5 times daily. You may also take metformin. You will test your blood sugar regularly and may need to change your insulin dose.
When might this not be the right option for me?
Metformin
If you have:
  • severe kidney problems.
  • unstable heart failure.
GLP-1 Receptor Agonist
If you have:
  • slowed digestion.
  • pancreas or gallbladder problems.
  • family history of thyroid cancer or hormone gland tumors.
SGLT2 Inhibitor
If you:
  • need dialysis.
  • have frequent bladder or yeast infections.
  • have low blood pressure.
DPP-4 Inhibitor
If you:
  • have pancreas problems.
  • are already taking a GLP-1 receptor agonist.
Sulfonylurea
If you:
  • are an older adult.
  • have a high risk of having a low blood sugar.
Pioglitazone
If you have:
  • heart failure.
  • bladder cancer or are at risk of it.
  • osteoporosis.
  • abnormal liver tests.
Insulin
Most people can take insulin. Finding the right dose can be harder if you have a high risk of having a low blood sugar.
How much will it lower my A1c level?
Metformin
It can lower your A1c by about 0.9%.
GLP-1 Receptor Agonist
It can lower your A1c by about 1.2%. If you take it with metformin, it can lower your A1c by about 1.8%.
SGLT2 Inhibitor
It can lower your A1c by about 0.8%. If you take it with metformin, it can lower your A1c by about 1.5%. It may not lower A1c levels as much if you have severe kidney problems.
DPP-4 Inhibitor
It can lower your A1c by about 0.6%. If you take it with metformin, it can lower your A1c by about 1.4%.
Sulfonylurea
It can lower your A1c by about 0.9%. If you take it with metformin, it can lower your A1c by about 1.5%.
Pioglitazone
It can lower your A1c by about 0.9%. If you take it with metformin, it can lower your A1c by about 1.5%.
Insulin
It can lower your A1c to the level you need.
Metformin
No
GLP-1 Receptor Agonist
No
SGLT2 Inhibitor
No
DPP-4 Inhibitor
No
Sulfonylurea
Yes
Pioglitazone
No
Insulin
Yes
Metformin
You may have short-term diarrhea, nausea, vomiting, and problems absorbing vitamin B-12.
GLP-1 Receptor Agonist
You may have short-term diarrhea, nausea, and vomiting. You may have itching and mild swelling where you give the shot.
SGLT2 Inhibitor
You may have bladder or vaginal yeast infections. Some people may have a short-term change in kidney function.
DPP-4 Inhibitor
You may have headaches, flu-like symptoms, and joint pain.
Sulfonylurea
You may have diarrhea, nausea, dizziness, and headaches.
Pioglitazone
You may have headaches, leg swelling, and a higher risk of broken bones and heart failure.
Insulin
You may have nausea, dizziness, and headaches. You may have rashes, itching, bruising, or lumps where you give the shot.
Metformin
You may lose a small amount of weight.
GLP-1 Receptor Agonist
You will likely lose weight.
SGLT2 Inhibitor
You may lose weight.
DPP-4 Inhibitor
Your weight may not change.
Sulfonylurea
You may gain weight.
Pioglitazone
You may gain weight.
Insulin
You may gain weight.
Metformin
Under $5.
GLP-1 Receptor Agonist
About $900.
SGLT2 Inhibitor
About $500.
DPP-4 Inhibitor
About $500.
Sulfonylurea
About $10.
Pioglitazone
About $5.
Insulin
The cost will depend on the kind of insulin you use and how much you need.
Definitions

A1c: Your A1c is measured by a blood test. The results are shown as a percentage and measure your average blood sugar over 3 months.

GLP-1 Receptor Agonist: This means glucagon-like peptide-1 receptor agonists. These medicines treat type 2 diabetes. These medicines end with “-tide”, like exenatide, liraglutide, and semaglutide.

SGLT2 Inhibitor: This means sodium-glucose cotransporter-2 inhibitors. These medicines treat type 2 diabetes. These medicines end with “-gliflozin”, like canagliflozin, dapagliflozin, and empagliflozin.

DPP-4 Inhibitor: This means dipeptidyl peptidase IV inhibitors. These medicines treat type 2 diabetes. These medicines end with “-gliptin”, like linagliptin, saxagliptin, sitagliptin.

Sulfonylurea: These medicines treat type 2 diabetes. These medicines usually end with “-ride” or “-zide”, like glimepiride, glipizide, and glyburide.

Take a brief survey about this tool
FAIR Health
The EBSCO Health Option Grid ™ decision aids are not intended to be medical advice, diagnosis or treatment and are intended to provide information to help people engage in shared decision making with health professionals.
EBSCO Health