What are the main classes of type 2 diabetes medication?

Commonly discussed classes include metformin (a biguanide), SGLT2 inhibitors, GLP-1 receptor agonists, DPP-4 inhibitors, sulfonylureas, thiazolidinediones, and insulin. Each works in a different way to help manage blood glucose. Which one is appropriate depends on the individual and is decided with a clinician.

Which diabetes medication is usually started first?

Metformin is commonly used as a first-line medication for type 2 diabetes, alongside lifestyle measures, though this is not universal. Some people may start with or add other classes depending on their overall health, other conditions, and goals. The American Diabetes Association describes an individualized approach in its Standards of Care.

Do some diabetes medications have benefits beyond glucose?

Yes. Research has shown that certain SGLT2 inhibitors and GLP-1 receptor agonists can offer cardiovascular and, for some, kidney benefits for particular groups of people. These findings are one reason treatment is tailored to the whole person rather than to glucose alone. Any medication choice should be made with a clinician.

Type 2 diabetes · medications

Type 2 Diabetes Medications: An Overview

7 min read · Updated July 2026

There is no single "diabetes pill." Instead, there are several families of medication, each working on the body in a different way to help keep blood glucose in a healthier range. This is an educational tour of the main classes — what they broadly do and why the right choice depends on the whole person. It is not a recommendation, and it does not replace the guidance of a clinician who knows your history.

This overview is part of our wider type 2 diabetes guide, which acts as the hub for this topic. Two of the classes below have their own deeper explainers: metformin and GLP-1 receptor agonists.

Metformin (a biguanide)

Metformin is commonly used as a first-line medication in type 2 diabetes. It works mainly by lowering the amount of glucose the liver releases and by helping the body respond better to its own insulin. On its own it generally does not cause low blood sugar (hypoglycemia). The most common considerations are gastrointestinal, and it is often started alongside lifestyle changes. We cover it in depth in Metformin, Explained.

SGLT2 inhibitors

SGLT2 inhibitors help the kidneys remove excess glucose from the body through the urine. Beyond lowering glucose, research has shown that some medications in this class can offer cardiovascular and kidney benefits for certain people, which is why they are often discussed for individuals who also have heart or kidney concerns — a link explored in our guide to diabetes and kidney disease. As with any class, suitability and monitoring are individual decisions.

GLP-1 receptor agonists

GLP-1 receptor agonists mimic a natural gut hormone that increases insulin release when glucose is high, reduces appetite, and slows how quickly the stomach empties. This often improves glucose and can support weight loss, and some have shown cardiovascular benefit in studies. Most are given by injection, though an oral option exists. See GLP-1 Receptor Agonists, Explained for the full picture.

DPP-4 inhibitors, sulfonylureas, and TZDs

Several other established classes are used depending on the situation:

DPP-4 inhibitors work on the same incretin system as GLP-1 medications, but through a different mechanism, helping the body use its own hormones more effectively. They are taken by mouth and are generally well tolerated.
Sulfonylureas prompt the pancreas to release more insulin. They are long-established and inexpensive, but because they can lower glucose regardless of intake, low blood sugar is a recognised consideration.
Thiazolidinediones (TZDs) improve the body's sensitivity to insulin. Like every class, they carry specific considerations that a clinician weighs against the potential benefit.

Insulin

Insulin replaces or supplements the body's own supply and can be an important option at various points in type 2 diabetes, not only late in its course. There are different types that act over different time frames, and dosing is carefully individualized. Because insulin directly lowers glucose, avoiding low blood sugar is part of how it is managed and monitored with a care team.

Why treatment is individualized

With so many options, choosing among them is not about finding one "best" drug. The American Diabetes Association's Standards of Care describe a person-centred approach: the choice depends on other conditions (such as heart or kidney disease), the risk of low blood sugar, effects on weight, cost and access, and personal preference. A plan may combine more than one class, and it can change over time as circumstances change. Progress is often tracked against individualized A1c targets.

Crucially, prescribing, choosing, and monitoring any diabetes medication are decisions made with a qualified clinician. Endobits is clinical decision-support software used under clinician oversight — it helps organise and interpret data to support those conversations, and it is not a prescriber.

Putting your data in context

See how glucose data can be organised alongside your clinical picture — a useful starting point for a conversation with your care team.

Check your glucose

Sources

American Diabetes Association — Standards of Care in Diabetes (Pharmacologic Approaches to Glycemic Treatment). National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) — Insulin, Medicines, & Other Diabetes Treatments. U.S. Food and Drug Administration — Diabetes Medications.

This article is educational and not medical advice. It describes drug classes in general terms and does not include doses or recommend any specific treatment. Medication choice, prescribing, and monitoring are individualized decisions made with a qualified healthcare provider. Endobits is clinical decision-support software used under clinician oversight, not a prescriber or diagnostic device.