Glucose‐lowering drugs

In the majority of patients with type 2 diabetes lifestyle measures, that is, diet and exercise, must be supplemented with appropriate pharmacological therapy in order to attain glycemic targets that are appropriate for the individual. Balancing the risk–benefit profile of glucose-lowering drugs, and setting and maintaining glycemic targets appropriate to the individual have become major tenets of modern diabetes therapy. Metformin (dimethylbiguanide) is the preferred agent first-line therapy if lifestyle modifications alone are not adequate to achieve glycemic goals, in both younger and older adults with diabetes. When used as monotherapy, thiazolidionediones can reduce fasting plasma glucose by 2–3 mmol/l and lower HbA1c by approximately 1.5%. All sulfonylureas are metabolized by the liver with metabolite activity and routes of elimination varying between individual drugs. Meglitinides, which preferentially act to reduce post-prandial hyperglycemia, have similar efficacy to metformin in terms of overall glycemic control.