Type 2 Diabetes Treatment: Medication, Lifestyle Changes, and More

While healthy habits like eating well and moving more are the foundation of care, many people also need medication. Your treatment plan will depend on your specific health needs, so always talk to your doctor before starting or changing any treatment.

Medication

"While primary care physicians may still follow the old idea that metformin is 'first line,' I think most endocrinologists have been using GLP-1 receptor agonists and SGLT2 inhibitors as best-in-class therapy for nearly a decade," says Michael Uzmann, MD, a dual board-certified endocrinologist and internist at A1Endocrinology in Las Vegas.

Menachem Jacobs, MD, the medical cofounder at Outlive Biologyand a resident physician at Yale New Haven Hospital in Connecticut, agrees. "Recently ... I shifted my strategy. I am now making it my top priority to safeguard the kidneys and heart right away," he says. "My go-to medications for patients with renal disease or heart failure are SGLT2 inhibitors or GLP-1 agonists. Organs are really saved by them."

Here are the main classes of diabetes medications.

Biguanides

GLP-1 Receptor Agonists

• dulaglutide (Trulicity)
• exenatide (Byetta)
• liraglutide (Victoza)
• lixisenatide (Adlyxin)
• semaglutide (Ozempic, Rybelsus)

Dual and Triple Agonists

• tirzepatide (Mounjaro)

SGLT2 Inhibitors

• bexagliflozin (Brenzavvy)
• canagliflozin (Invokana)
• dapagliflozin (Farxiga)
• empagliflozin (Jardiance)
• ertugliflozin (Steglatro)

DPP-4 Inhibitors

• alogliptin (Nesina)
• linagliptin (Tradjenta)
• saxagliptin
• sitagliptin (Januvia)

Sulfonylureas

• glimepiride glipizide
• glyburide (DiaBeta)

Meglitinides

Medications in this class are: repaglinide and nateglinide.

Thiazolidinediones

D2 Argonist

Insulin

"Most patients with type 2 diabetes who require insulin start with a single injection of long-acting (basal) insulin given once daily," says Kathleen Dungan, MD, an endocrinologist at the Ohio State University Wexner Medical Center in Columbus.

Surgery

Gastric Bypass

Gastric Sleeve

Lifestyle Changes

Medication works best when paired with healthy habits. While “diet and exercise” is common advice, it can feel vague. The key is finding specific, sustainable changes that work for you.

Nutrition

There is no single “diabetes diet,” but experts recommend focusing on whole foods. "I recommend following a good diet that is rich in anti-inflammatory foods, lean proteins, lots of fiber, and carb-controlled food decisions," says Janelle Bober, RDN, a dietitian with Dietitian Live who’s based in Fort Collins, Colorado. This doesn’t mean you have to get rid of carbs completely, but pairing them with healthy fats and proteins can limit blood sugar spikes.

If you had to pick one major change, Dr. Uzmann says to cut out sodas. "They don't fill people up, and the calories are basically zero benefit," he says. Uzmann also recommends learning to cook simple meals. This teaches you about portions and ingredients, and it can change your perspective on healthy foods. "'I don't like vegetables' can quickly change to 'I didn't like vegetables prepared in a certain way,'" he says.

Physical Activity

• Start small. "You might really want to run a marathon, but if you're not doing any exercise at all, start with a 'no-brainer' goal like 10 minutes of cardiovascular exercise," says Claudine Holt, MD, MPH, a board-certified lifestyle medicine physician.
• Build muscle. Strength training helps build lean muscle mass, which is important for regulating metabolism and blood sugar levels. "Glucose is stored in our muscles and our liver,” says Bober. "So when we're using our muscles regularly, we have a little bit better management.”
• Move at work. Uzmann suggests adding movement to your workday, like walking at lunch. "Something as simple as 10 to 15 minutes boosts metabolism and helps avert low energy during the later part of the day," he says.

Sleep

"Choose a specific time to go to bed, like 10:30 p.m., and stick to it every night,” says Dr. Jacobs. "This includes the weekends. You need to train your circadian rhythm the same way you train a muscle.”

Making lifestyle changes stick is often the hardest part of treatment. Dr. Holt advises focusing on consistency rather than perfect results immediately.

"As the saying goes, the journey of a thousand miles begins with a single step," says Holt. "As long as you keep that in perspective, one step forward will always mean something, even if you aren't at your final destination yet.”

Complementary and Integrative Approaches

While no supplement can replace diabetes medication, some integrative approaches may help support your health. For example, Bober notes that certain herbs, such as berberine, ginkgo, and cinnamon, have been used to manage diabetes. Jacobs adds that soluble fiber, like psyllium husk, can slow down food absorption to prevent sugar spikes.

"One more choice I think about is magnesium," says Jacobs. "Many people with type 2 diabetes don't have enough magnesium in their bodies. [Addressing any deficiency] can make insulin work better."

Always consult your doctor before adding supplements, as they can interact with your medications or cause harm if used incorrectly.

"In the emergency room, I've seen people whose blood sugar got too high because they switched from insulin to bitter melon tea or cinnamon pills,” Jacobs warns. “Supplements can help your treatment, but they don't usually take the place of it."

Pain Management

"Neuropathy is very complex and difficult to manage. The first step is obviously improving glycemic control," says Uzmann. Keeping your blood sugar in a healthy range stops the damage from getting worse.

If you’re dealing with a new injury rather than chronic nerve pain, Jacobs advises going back to basics. "I also really think that the RICE [rest, ice, compression, and elevation] method should be used for new injuries. Take it easy, put ice on it for 20 minutes, wrap it up, and raise it above your heart," he says. “A lot of people don't do these easy things, but they really help lower inflammation a lot.”

Mental Health Treatment

"We're also understanding the impact of our mindset and our behavior," says Bober. "Building on a person's identity and allowing them to take control over their scenario ... can really help people to take back their power.”

• Therapy Cognitive behavioral therapy (CBT) can help you manage stress.

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• Mindfulness Techniques like deep breathing or meditation can lower stress levels.
• Medication If needed, antidepressants or anti-anxiety medications can help.

The Takeaway

• Doctors now focus on protecting your heart and kidneys and on managing weight with newer drugs such as GLP-1s and SGLT2s.
• Simple habits like following a diet rich in anti-inflammatory foods, lean proteins, and fiber, limiting carbs, building muscle, and prioritizing sleep make a huge difference.
• If you have nerve pain, you may be able to find temporary relief via better sugar control, specific medications, and certain at-home remedies like cold rolling.
• Always consult a healthcare professional before starting supplements or making significant changes to your diet or exercise routine.