Auntie Zhu and Auntie Chen are residents of the same neighborhood, similar in age, they usually exercise, activities are together, feelings are very close, and the two aunties also have a common point, they are type 2 diabetic patients, which is what we call “sugar lovers”, usually are oral hypoglycemic drugs to control blood sugar. But careful people found that the two aunts are similar in age, eating, exercise are very similar, and are not hypertension, coronary heart disease and other chronic diseases, but their treatment plan is very different, this is why? After asking the local community doctor, the original situation is this: Auntie Zhu has a fat body type and a thick waistline, so the doctor suggested that on the basis of diet control and strengthening exercise, you can usually take biguanides, while Auntie Chen has a thin body type and less fat, so she takes sulfonylurea hypoglycemic drugs. It seems that different diabetic patients need to pay attention not only to age, gender, type of diabetes, heart, liver, kidney and other organ functions, but also to the difference in body type when choosing oral medications. The body type here is not the simple term “tall, short, fat and thin” in our life, but is differentiated according to body mass index (BMI) and waist circumference index (WC), where BMI is calculated by dividing weight (kg) by the square of height (m). In general, we believe that BMI greater than or equal to 25 is overweight or obese, while less than 18.5 belongs to wasting or malnutrition. And women with waist circumference greater than 80cm and men with waist circumference greater than 85cm are also obese. So, different body types of diabetic patients, the face of all kinds of oral hypoglycemic drugs, how should we choose? At present, there are five major categories of oral hypoglycemic drugs commonly used on the market in China, namely: biguanides, sulfonylureas, alpha-glucosidase inhibitors, thiazolidinediones, and glinides. In addition, there are some herbal hypoglycemic preparations, etc., which are omitted here. These five drugs have different mechanisms of action, respectively: 1, metformin: mainly refers to metformin, the mechanism of action is to suppress appetite and the body’s absorption of glucose, reduce the liver’s ability to output glucose, and strengthen the body’s sensitivity to insulin. Applicable objects include type 1 and type 2 diabetic patients, and metformin is recommended as the first-line drug for diabetes in many guidelines at home and abroad, especially for those with strong appetite and heavy weight. In addition, metformin can also reduce the level of blood lipids, is the first choice for patients with diabetes combined with high blood lipids. 2, sulfonylurea: mainly through the promotion of insulin secretion to play a role in lowering glucose, such as Damacell, sugar flat, Rui Yi Ning. After the stimulation of insulin by sulfonylureas, the patient’s appetite may be enhanced, sugar utilization may be improved, and the amount of sugar loss from urine may be reduced, so to a certain extent, the weight may be increased. Therefore, it is more appropriate to use sulfonylureas for patients with light or normal weight. 3.α-glucosidase inhibitors: such as Bystolic, carboplatin, the main effect is to inhibit the absorption of sugar to reduce postprandial blood sugar, so it is suitable for all types of diabetes, especially those with high postprandial blood sugar. As the name suggests, it can increase insulin in the body through various ways without stimulating insulin secretion. However, long-term use of these drugs can increase water retention in the body, which can lead to weight gain. In addition, there are recent foreign reports that the long-term use of Ventia can increase the burden on the heart, increasing the risk of heart disease, cardiac insufficiency need to be used with caution. 5, glinides: This is also a class of drugs to promote insulin secretion, including Tangli, Novaluron, etc. The mechanism of action is similar to that of sulfonylureas, and its application is mainly for those who are not fat and have a certain secretion capacity of the pancreas, but fail to sulfonylurea. Combined with China’s diabetes prevention and treatment guidelines, the above can be summarized as follows: Type 1 diabetic patients can use insulin sensitizers (including biguanides) and α-glucosidase inhibitors in combination with insulin therapy, and should not use pro-insulin secretagogues. In contrast, in type 2 diabetic obese people, biguanides, α-glucosidase inhibitors or insulin sensitizers are preferred, followed by proinsulin secretagogues. In type 2 diabetic wasting people, pro-insulin secreting agents or insulin sensitizing agents are preferred and can be combined with alpha-glucosidase inhibitors or biguanides. In addition, there are some special precautions when taking some drugs, such as sulfonylureas should be taken 15-20 minutes before eating; biguanides due to heavy gastrointestinal reactions, after the meal can reduce these adverse reactions; Bystolic should be eaten when the main food (rice, noodles), and the first bite of rice chewed and swallowed at the same time, and so on. All in all, it is a basic principle of rational drug use to choose the most suitable drug for each patient’s specificity. The use of hypoglycemic drugs should be in accordance with medical advice, starting with a small dose and adjusting as appropriate according to blood glucose and urine sugar, so as to achieve long-term and stable control of blood glucose, delay the occurrence of diabetic complications and improve the quality of life of patients.