Hello to all diabetics and health-conscious individuals!

Do you feel a bit confused every time you face a string of drug names prescribed by the doctor?

Metformin, SGLT2 inhibitors, DPP-4 inhibitors... which one is more effective? Which one is more suitable for me?

Don't worry! Today, we will follow the latest "Chinese Guidelines for the Prevention and Treatment of Type 2 Diabetes," combined with strategies to reduceGlycated hemoglobin (HbA1c)The effect of, to provide a clear overview for everyoneOral Hypoglycemic Drug "Power Ranking"。

Important Note:This article is for educational purposes only to help you understand the medication.All medication adjustments must be discussed with your doctor!Individual circumstances vary, and what is most suitable for you is the best.

Ranking basis: HbA1c reduction effect

Glycated hemoglobin (HbA1c) is the "gold standard" for reflecting the average blood glucose level over the past 2-3 months. We primarily refer to the extent of HbA1c reduction by various medications and introduce them in combination with their characteristics.

Number 1: Oral GLP-1 Receptor Agonist

Representative drugsSemaglutide Tablets
Hypoglycemic effectLower HbA1c1.5%~1.6%
Characteristics：

  • ✅AdvantagesLowering blood sugar and reducing weight "with a dual approach," while also providing clear cardiovascular and renal protection, and does not cause hypoglycemia when used alone.
  • ❌DisadvantagesGastrointestinal reactions such as nausea and decreased appetite are relatively common.
  • ⚠️AttentionPatients with a history of severe gastrointestinal diseases or pancreatitis are not recommended for use.

2nd Place: Biguanides (Classic Cornerstone)

Representative drugsMetformin (Immediate-Release Tablets/Extended-Release Tablets)
Hypoglycemic effectLower HbA1c1.0% to 1.5%
Characteristics：

  • ✅AdvantagesClinically proven efficacy, affordable price, and no risk of hypoglycemia, recommended by domestic and international guidelines.First-line preferred and full-course medication。
  • ❌DisadvantagesSome individuals may experience abdominal distension and diarrhea.
  • ⚠️AttentionContraindicated in cases of severe hepatic and renal insufficiency, hypoxia, etc.

No. 3: Sulfonylureas (Veteran Powerhouse)

Representative drugsGlimepiride, Gliclazide, etc.
Hypoglycemic effectLower HbA1c1.0% to 1.5%
Characteristics：

  • ✅AdvantagesIt has strong hypoglycemic efficacy, particularly effective in lowering fasting blood glucose.
  • ❌DisadvantagesThere is a risk of causing hypoglycemia and weight gain.
  • ⚠️NoteStart with a low dose and monitor blood glucose levels closely.

4th: Glinides (Postprandial Guardians)

Representative drugsRepaglinide, Nateglinide
Hypoglycemic effectLower HbA1c0.5% to 1.5%
Characteristics：

  • ✅Advantages"Fast in, fast out," primarily controls postprandial blood glucose and offers flexible usage.
  • ❌DisadvantagesIt may also lead to hypoglycemia and weight gain.

No. 5: SGLT2 Inhibitors ("Gliflozin" Class, Emerging Star for Heart and Kidney Protection)

Representative DrugsDapagliflozin, Empagliflozin, etc.
Hypoglycemic effectLower HbA1c0.5% to 1.2%
Characteristics：

  • ✅AdvantagesExcreting glucose through urine provides clear cardiorenal protective effects and can reduce weight and lower blood pressure.
  • ❌DisadvantagesMay increase the risk of urogenital tract infections.
  • ⚠️AttentionIt is recommended to drink plenty of water and pay attention to personal hygiene.

6th-11th Place: Other Distinctive Medications

Ranking

Category

Representative drugs

Core Features and Precautions

6

Thiazolidinediones

Pioglitazone

Improve insulin resistance, but be aware of the risks of edema and fractures.

7

DPP-4 inhibitors

("gliptin" class)

Sitagliptin, Linagliptin

Stable blood sugar reduction without increasing the risk of hypoglycemia or weight gain, with high safety.

8

PPAR pan-agonist

Sitagliptin Sodium

Simultaneously improving blood glucose and blood lipids requires attention to edema.

9

Glucokinase Activator

Dorzagliatin

Reshaping Glucose Homeostasis, Novel Mechanism Drug.

10

Alpha-glucosidase inhibitors

Acarbose

Primarily reduces postprandial blood glucose, abdominal distension and flatulence are relatively common.

11

Chinese Patent Medicine Category

Jinlida Granules, Xiaoke Pills, etc.

Must be used according to TCM syndrome differentiation.

Chinese patent medicines containing "glibenclamide" require caution for hypoglycemia.

Lao Wang's Summary and Key Reminders

  1. Ranking is not the sole criterion.Efficacy (glucose-lowering effect) is only one aspect of drug selection; doctors will also comprehensively consider factors such as your weight, cardiovascular and renal conditions, hypoglycemia risk, and financial situation.
  2. Combination therapy is the normDiabetes is a progressive disease, and when monotherapy fails to provide adequate control, combination therapy is a scientifically sound and common strategy.
  3. Good medicine does not equal expensive medicineClassic old drugs like metformin remain the cornerstone of treatment with high efficacy and cost-effectiveness.
  4. New drug shows promising featuresGLP-1 agonists and SGLT2 inhibitors demonstrate cardiorenal protective effects beyond glucose lowering, offering a superior choice for individuals with diabetes who have related comorbidities.
  5. Safety always comes firstUnderstand the potential side effects of the medication and communicate any discomfort thoroughly with your doctor.