Table 3

Drugs for treating type 2 diabetes in adults (not including insulin or insulin analogs) but not yet approved in youth except for metformin

Drug class	Available drugs in this class	Mechanism of action	Significant adverse effects	Approved in patients <18 years old
Biguanides	Metformin	Decreases insulin resistance; reduces hepatic glucose production; increases peripheral glucose uptake; decreases gastrointestinal absorption of glucose	Gastrointestinal Lactic acidosis	Yes
Sulfonylureas	Glipizide Glimepiride Glyburide	Stimulates secretion of insulin from the β-cell	Hypoglycemia Weight gain	No
Meglitinides	Repaglinide Nateglinide	Stimulates glucose-dependent secretion of insulin from the β-cell	Hypoglycemia URI Diarrhea Headache	No
α-Glucosidase inhibitors	Acarbose Miglitol	Delays absorption of glucose by intestines by inhibiting breakdown of complex sugars	Flatulence Diarrhea Abdominal cramps	No
GLP-1 agonists	Exenatide Liraglutide Dulaglutide Lixisenatide Albiglutide Semaglutide	Incretin effect; slows gastric emptying; enhances postprandial insulin biosynthesis; improves β-cell function; decreases appetite	Acute pancreatitis C-cell hyperplasia/ medullary thyroid carcinoma Nausea/vomiting Hypoglycemia Diarrhea Headache	No
DPP-4 inhibitors	Saxagliptin Sitagliptin Alogliptin Linagliptin	Inhibits DPP-4 enzyme, reducing endogenous GLP-1 breakdown	Acute pancreatitis URI UTI Nasopharyngitis Headache	No
Amylin analog	Pramlintide	Inhibits postprandial glucagon secretion; delays gastric emptying; improves satiety	Hypoglycemia Nausea Anorexia Abdominal pain	No
Thiazolidinediones	Rosiglitazone Pioglitazone	PPAR-γ inhibitor; increases insulin sensitivity in liver, muscle, and adipose tissue; decreases hepatic glucose output	Edema Weight gain Anemia Elevated liver enzymes	No
SGLT-2 inhibitors	Canagliflozin Dapagliflozin Empagliflozin Ertugliflozin	Allows more glucose to be excreted in the urine and hence lowers blood glucose	Euglycemic ketoacidosis UTI Candidal vulvovaginitis	No
Bile acid sequestrant	Colesevelam	Mechanism for glucose lowering is unknown	Gastrointestinal (gas, nausea, diarrhea, abdominal pain) Weakness Muscle pain	No
Dopamine-2 agonist	Bromocriptine (quick release)	Modulates hypothalamic regulation of metabolism; increases insulin sensitivity	Nausea/vomiting Fatigue Dizziness Headache	No

DPP-4, dipeptidyl peptidase 4; GLP-1, glucagon-like peptide 1; PPAR, peroxisome proliferator–activated receptor; SGLT2, sodium–glucose cotransporter 2; URI, upper respiratory infection; UTI, urinary tract infection.