Type 2 Diabetes Management : Main Classes of Medications

Medication Class	Medications	Mechanism of Action	Indications and Notes	Contraindications /Special Warnings	Hypoglycaemia Risk	Renal Impairment	Hepatic Impairment
Metformin	Metformin	Decreases hepatic glucose production, increases insulin sensitivity	First-line treatment for most adults with type 2 diabetes. Gradual dose increase to minimize GI side effects.	Acute metabolic acidosis	Low	Dose reduction or avoid. Check BNF for eGFR thresholds	Withdraw if tissue hypoxia likely
SGLT2 Inhibitors	Canagliflozin, Dapagliflozin, Empagliflozin, Ertugliflozin	Inhibit renal glucose reabsorption, increasing glucose excretion	For patients with cardiovascular disease, chronic kidney disease, or high cardiovascular risk. Check for DKA risk.	Ketoacidosis	Low	Dose reduction or caution or avoid. Check BNF for eGFR thresholds	Caution or avoid. Check BNF for severity
DPP-4 Inhibitors	Alogliptin, Linagliptin, Saxagliptin, Sitagliptin, Vildagliptin	Increase incretin levels, inhibit glucagon release, increase insulin secretion	Alternative if metformin is contraindicated or not tolerated.	Ketoacidosis	Low	Dose reduction or caution (not for linagliptin)	Caution or avoid (not for linagliptin and sitagliptin)
Sulfonylureas	Gliclazide, Glimepiride, Glipizide, Tolbutamide	Stimulate insulin release from pancreatic beta cells	Consider if metformin is contraindicated or not tolerated. Risk of hypoglycemia.	All: ketoacidosis. Gliclazide and tolbutamide: avoid in acute porphyrias	Moderate to High	Dose reduction or caution or avoid. Check BNF for eGFR thresholds	Caution or...

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