• deficient secretion of insulin from the pancreas;
• resistance to the physiologic effects of insulin; and
• unrestrained production and release of glucose from the liver.

Medications used to treat T2D alter these pathophysiological processes. Some medications stimulate the pancreas to produce more insulin. All oral agents that stimulate increased insulin production can cause hypoglycemia. Other drugs decrease insulin resistance at the tissue level or interfere with glucose production and release from the liver. A separate class of oral anti-diabetes agents slows the intestinal absorption of carbohydrates.

Oral anti-diabetes drugs are most commonly used for patients who are obese, are more than 40 years old, and have stable T2D of less than 5 years duration. Oral anti-diabetes drugs are used as an adjunct to dietary and exercise management strategies to manage T2D. Oral anti-diabetes agents are not appropriate for patients with the following conditions:

• Type 1 diabetes (T1D)
• Allergy to sulfonylurea compounds
• Pregnancy or lactation – the effect of oral anti-diabetes agents on the fetus and newborn is unknown. Women who are attempting to become pregnant or who are unsure of when they might become pregnant should avoid using oral anti-diabetes agents.
• Major surgery, serious infection, trauma, and conditions such as acute myocardial infarction – these are situations of high stress in which oral anti-diabetes agents are often ineffective in controlling high blood glucose levels.
• Impaired hepatic or renal function – oral anti-diabetes agents are metabolized in the liver and most are excreted by the kidney. Serious episodes of hypoglycemia or worsening renal function can occur in patients with poor kidney or liver function.
  

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