Diabetes mellitus is a metabolic disorder characterized by chronic hyperglycemia and mainly includes type 1 diabetes mellitus (T1DM) and type 2 diabetes mellitus (T2DM). Among them, T2DM accounts for more than 90% of all diabetes cases.
With a deeper understanding of the pathophysiology of diabetes, the range of antidiabetic medications and treatment strategies has continued to expand. From traditional oral hypoglycemic agents to innovative drugs targeting metabolic pathways and providing cardiovascular and renal protection, patients now have access to more individualized therapeutic options.

I. Main Therapeutic Goals of Antidiabetic Medications

The core objectives of pharmacological treatment for diabetes include:

  • Effectively lowering blood glucose levels and achieving target HbA1c

  • Reducing the risk of hypoglycemia

  • Controlling body weight or avoiding weight gain

  • Preventing or delaying cardiovascular, renal, and other diabetes-related complications

Currently, commonly used antidiabetic drugs can be classified according to their mechanisms of action. DengyuePharma has summarized these medications in the following table.

II. Classification of Common Antidiabetic Drugs and Representative Agents

Drug Class Representative Drugs Main Mechanism of Action Indications and Key Features
Biguanides Metformin Inhibits hepatic glucose production and improves insulin sensitivity First-line therapy for T2DM; does not cause weight gain; low risk of hypoglycemia
Sulfonylureas Glimepiride, Gliclazide Stimulate insulin secretion from pancreatic β-cells Rapid onset; higher risk of hypoglycemia and weight gain
Glinides Repaglinide, Nateglinide Short-acting stimulation of insulin secretion Mainly reduces postprandial glucose; short duration of action
α-Glucosidase Inhibitors Acarbose, Voglibose Delay intestinal absorption of carbohydrates Primarily reduce postprandial glucose; common gastrointestinal side effects
Thiazolidinediones (TZDs) Pioglitazone Improve insulin sensitivity in peripheral tissues Improve insulin resistance; may cause weight gain and fluid retention
DPP-4 Inhibitors Sitagliptin, Linagliptin Increase endogenous GLP-1 levels and enhance insulin secretion Low risk of hypoglycemia; weight-neutral
GLP-1 Receptor Agonists Liraglutide, Semaglutide Enhance insulin secretion, suppress appetite, delay gastric emptying Promote weight loss; some agents provide cardiovascular benefits
SGLT2 Inhibitors Dapagliflozin, Empagliflozin Promote urinary glucose excretion Provide cardiovascular and renal protection
Insulin Preparations Insulin glargine, Insulin aspart Direct supplementation of exogenous insulin Indicated for T1DM and selected T2DM patients

III. Development Trends in New Antidiabetic Therapies

In recent years, diabetes management has shifted from a sole focus on glycemic control to a more comprehensive approach.
Newer agents, particularly GLP-1 receptor agonists and SGLT2 inhibitors, not only achieve effective glucose lowering but also demonstrate clear benefits in cardiovascular disease and chronic kidney disease, gradually reshaping the diabetes treatment landscape.

In addition, the development of long-acting formulations, oral GLP-1 agents, and dual- or multi-target therapies offers new opportunities to improve patient adherence and therapeutic outcomes.

IV. Summary

Antidiabetic drugs are diverse, and each class differs in mechanism of action, efficacy, adverse effects, and suitable patient populations.
In clinical practice, individualized treatment strategies should be developed based on a patient’s glycemic control, risk of complications, body weight, and drug tolerance, with the goal of achieving long-term stable blood glucose control and improving overall prognosis.