There are currently eight main classes of hypoglycemic drugs according to different mechanisms of action, including oral hypoglycemic agents and injectables. The main oral hypoglycemic agents are sulfonylureas, metformin, α-glucosidase inhibitors, thiazolidinediones, DPP-4 enzyme inhibitors, and SGLT2i inhibitors. Injectable agents include insulin and GLP-1 receptor agonists.
Second-generation sulfonylureas in the sulfonylurea class are fast-acting and effective, but be aware of hypoglycemia; metformin is the first-line hypoglycemic agent of choice for most patients with type 2 diabetes, which has the benefit of not acting on normal people and causing fewer hypoglycemic symptoms than sulfonylureas, mainly for obese patients with type 2 diabetes; it is irritating to the gastrointestinal tract, so it should be taken with meals to reduce the effect on Alpha-glucosidase inhibitors, mainly reduce postprandial blood sugar, especially for patients with high postprandial blood sugar without high fasting blood sugar, and these drugs have effects on antihypertensive, lipid-lowering, anti-atherosclerosis and kidney protection; GLP-1 agonist is a new drug, and its main mechanism is to promote insulin secretion, inhibit glucagon secretion, reduce appetite by controlling the nerve center body weight, etc., to control blood glucose.
Most adverse reactions to glucose-lowering drugs have hypoglycemic symptoms (cold sweats, weakness, palpitations, shaking hands and feet, blurry eyes, headache), and it is important to be aware of these.