Six types of oral medicines (and 11 individual drugs) are now available to help the 21 million people in the U.S. with type 2 diabetes control their blood sugar when diet and lifestyle change are not enough.

Our evaluation of these medicines found the following:

• Newer drugs are no better. One older type of medicine, the sulfonylureas, and an older drug named metformin work just as well as four newer classes. Indeed, several of the newer drugs are less effective than the older ones.
• Newer drugs are no safer. All diabetes pills have the potential to cause adverse effects, both minor and serious. The drugs’ side effect “profiles” may be the most important factor in your choice.
• The newer drugs are more expensive. The newer diabetes medicines cost many times more than the older ones.
• Taking two diabetes drugs can improve blood sugar control. Many people with diabetes do not get enough help from one drug. Two may be necessary. However, taking two drugs can raise the risk of adverse effects and increase costs.

 Taking effectiveness, safety, side effects, dosing, and cost into consideration, we have chosen the following as Consumer Reports Best Buy Drugs if your doctor and you have decided that you need medicine to control your diabetes:

• Metformin – alone or in combination with glipizide or glimepiride
• Glipizide and Glipizide Sustained Release – alone or in combination with metformin
• Glimepiride – alone or in combination with metformin

These medicines are available as low-cost generics. If you have been diagnosed with diabetes, we recommend that you try metformin first unless your health status prevents it.

If metformin fails to bring your blood sugar into normal range, we recommend you add glipizide or glimepiride. Should either of those drugs cause problems, Actos (pioglitizone) may be an option you and your doctor will want to consider. Actos and Avandia (rosiglitizone) have been heavily promoted to doctors and consumers, however, and have been over-prescribed.