4 Outdated Diabetes Medications You Should Consider Upgrading

Type 2 diabetes is a health condition that causes high blood sugar (glucose). Over time, high blood sugar can lead to complications, such as nerve or kidney damage. For many people living with Type 2 diabetes, medication helps balance sugar levels and lower the risk of these long-term problems.

There are many medication options for managing Type 2 diabetes. What works for one person may not be right for someone else. But certain medications are less commonly prescribed than others. These medications often have a higher risk of serious side effects, such as low blood sugar (hypoglycemia).

So which medications aren’t a first choice for most people with Type 2 diabetes? Below, you’ll find information about four outdated diabetes medications.

4 outdated diabetes medications

Let's be clear: All Type 2 diabetes medications can be helpful, since they all lower blood sugar. But there are some that experts recommend trying first. Usually, first-choice medications work well to lower blood sugar and are less likely to cause serious side effects. Many of them also have other benefits, such as heart or kidney protection.

The American Diabetes Association recommends medications for diabetes based on these benefits. Outdated diabetes medications typically don’t have these benefits. And they tend to have a higher risk of certain side effects.

Still, an outdated medication is better than taking no medication at all. And your healthcare team may want you to take these medications for a specific reason. Everyone has a different situation. An outdated diabetes medication might be your best option for keeping your blood sugar in a healthy range.

Keep in mind: The outdated diabetes medications listed below typically cost less than newer medications. Cost is an important consideration when it comes to managing diabetes. Taking your medications as prescribed is key when it comes to balancing your blood sugar.

1. Thiazolidinediones, such as pioglitazone

Thiazolidinediones (TZDs, or glitazones) are a class of oral diabetes medications. They help lower blood sugar by:

• Making your body more sensitive to your natural insulin, which helps your body move sugar out of your bloodstream and into your cells

• Lowering the amount of new sugar your liver makes

• Protecting certain cells in your pancreas that make insulin

Pioglitazone (Actos) is the only TZD available in the U.S. It helps lower hemoglobin A1C (HbA1C or A1C) by about 1%. Your A1C represents your average blood sugar levels over the past 3 months. And pioglitazone is unlikely to cause low blood sugar.

But this medication can cause weight gain. And it can cause fluid buildup. This can worsen heart failure, a condition that’s commonly associated with diabetes. For these reasons, pioglitazone is usually not a first-choice medication for managing Type 2 diabetes.

2. Sulfonylureas, such as glipizide

Sulfonylureas are another class of oral Type 2 diabetes medications. They primarily work by causing your pancreas to release more insulin. This helps move sugar into your cells, lowering your blood sugar levels. Common sulfonylureas include:

• Glipizide (Glucotrol XL)

• Glyburide (DiaBeta, Glynase)

• Glimepiride

EXPERT PICKS: WHAT TO READ NEXT

• Prevent long-term problems: Taking your diabetes medications as prescribed helps lower the risk of long-term complications, such as kidney damage.

• Pills for diabetes: Read about which oral medications can treat Type 2 diabetes.

• Future treatment options: Learn which diabetes medications are being studied and when they might be FDA approved.

Sulfonylureas are still commonly prescribed, even though they’re not first-choice medications. They can help lower A1C by up to 1.5%. They also have lower-cost generic versions available. But they have two notable side effects to consider.

Sulfonylureas have a higher risk of causing low blood sugar. This risk goes up if you’re also taking other diabetes medications. Sulfonylureas also tend to cause weight gain for many people.

3. Meglitinides, such as repaglinide

Meglitinides (glinides) work similarly to sulfonylureas. But they don’t last as long in your body, so you’ll likely take more doses per day. Examples of glinides include repaglinide and nateglinide.

Glinides work about as well as sulfonylureas for lowering A1C. But they also have a risk of weight gain and low blood sugar. Glinides are less commonly prescribed because of these risks and because you have to take them more frequently.

4. Alpha glucosidase inhibitors, such as acarbose

Alpha glucosidase inhibitors are also oral diabetes medications. They work by slowing the absorption of carbohydrates from your small intestine. Examples of these medications include acarbose and miglitol (Glyset).

These medications are rarely used because of their side effects, such as gas and diarrhea. They also tend to provide less A1C reduction (about 0.5% to 1%) than some other options. Alpha glucosidase inhibitors usually work best for people who have high-carbohydrate diets. So if you’re following a low-carbohydrate diet, they may not work as well for you.

Best diabetes medications

The following diabetes medications are some of the most effective for lowering blood sugar. Many also have other health benefits. This makes them common first-choice options for managing Type 2 diabetes.

Metformin

Metformin belongs to the biguanide medication class. This oral medication helps lower blood sugar by:

• Lowering how much new sugar your liver makes

• Lowering how much sugar your body absorbs from foods and drinks

• Helping your body use its natural insulin better

Metformin has been a long-standing first-choice medication for Type 2 diabetes. It works well, providing an average A1C reduction of 1% to 1.5%. It also has a low risk of causing low blood sugar.

What’s more, metformin doesn’t usually affect body weight and may help protect the heart. Most people experience only mild side effects, which improve after a few weeks. The risk of serious side effects with metformin is very low.

GLP-1 receptor agonists, such as Ozempic

Glucagon-like peptide-1 (GLP-1) receptor agonists are popular diabetes medications. They work by acting like the natural gut hormone GLP-1. This has the following effects:

• Triggers your pancreas to release insulin after you eat

• Tells your liver to make less new sugar

• Slows the passage of food through the gut, making you feel fuller for longer

• Works in areas of the brain that balance appetite and food cravings

Popular GLP-1 receptor agonists include:

• Ozempic (semaglutide)

• Rybelsus (semaglutide) — an oral version of Ozempic

• Trulicity (dulaglutide)

• Mounjaro (tirzepatide) — both a GLP-1 and glucose-dependent insulinotropic polypeptide (GIP) receptor agonist

These medications work very well for lowering blood sugar (up to a 2% A1C reduction). They also can help people lose weight. For example, people using Ozempic in studies lost an average of 13 to 15 lbs after about 9 months.

Beyond blood sugar and weight loss benefits, some GLP-1 receptor agonists provide heart and kidney protection. They commonly cause digestive side effects, such as nausea, but these are generally mild. And they typically improve or stop with continued use.

SGLT2 inhibitors, such as Farxiga

Sodium-glucose cotransporter-2 (SGLT2) inhibitors are oral diabetes medications. They mainly work by removing extra sugar and sodium (salt) through your kidneys.

Popular SGLT2 inhibitors include:

• Jardiance (empagliflozin)

• Farxiga (dapagliflozin)

• Invokana (canagliflozin)

These medications can help lower A1C by up to 1%. So you’ll likely add an SGLT2 inhibitor to existing diabetes medications, such as metformin, rather than take it by itself. And SGLT2 inhibitors may lead to modest weight loss for some people who take them.

Similar to GLP-1 receptor agonists, SGLT2 inhibitors have benefits beyond managing diabetes. Some can also help manage other conditions, such as chronic kidney disease or heart failure. In fact, you can take certain SGLT2 inhibitors for these conditions even if you don’t have diabetes.

Most people can take SGLT2 inhibitors without serious side effects. But they can cause you to pee more than usual, and they raise the risk of urinary tract infections and genital yeast infections.

Why trust our experts?

Written by:

Austin Ulrich, PharmD, BCACP

Austin Ulrich, PharmD, BCACP, is a board-certified ambulatory care clinical pharmacist. In his early career, he provided direct patient care in a variety of settings, including hospital and community pharmacies, and in a primary care clinic as a clinical pharmacist.

Edited by:

Christina Aungst, PharmD

Christina Aungst, PharmD, is a pharmacy editor for GoodRx. She began writing for GoodRx Health in 2019, transitioning from freelance writer to editor in 2021.

Reviewed by:

Patricia Pinto-Garcia, MD, MPH

Patricia Pinto-Garcia, MD, MPH, is a medical editor at GoodRx. She is a licensed, board-certified pediatrician with more than a decade of experience in academic medicine.

Our editorial standards

Meet our experts