Treatment Guidelines from The Medical Letter
Drugs for Type 2 Diabetes
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The development of hyperglycemia in type 2 diabetes results from a combination of metabolic abnormalities including insulin resistance, diminished insulin secretion and excess hepatic glucose production. Diet, exercise and weight loss are helpful in improving glucose control, but most patients ultimately require drug therapy.

BIGUANIDESMetformin (Glucophage, and others), the only biguanide marketed in the US, decreases hepatic glucose output and, to a lesser extent, increases peripheral glucose utilization. Metformin produces about the same reduction in glycated hemoglobin (HbA1C) concentrations as a sulfonylurea, but typically causes modest weight loss (generally 2-3 kg) rather than weight gain, and fewer hypoglycemic events.

Metformin used to be contraindicated in all patients with heart failure, but in one large retrospective study in elderly patients (mean age 72) with type ... more      

The Medical Letter is a subscriber-funded nonprofit organization that publishes critical appraisals of new prescription drugs and comparative reviews of drugs for common diseases.

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Title: Drugs for Type 2 Diabetes
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