Medications for Type 2 Diabetes

 

Medications available in NZ

Class	PHARMAC Funding	Key Benefits / Caveats
Biguanides Metformin	Funded; generally widely accessible.	Good efficacy for HbA1c lowering, low cost; usually weight-neutral or modest weight loss; GI side effects; needs monitoring in renal impairment.
Sulfonylureas Gliclazide Glipizide Glibenclamide	Funded.	Strong HbA1c lowering; risk of hypoglycaemia; may cause weight gain; less favourable in people with cardiovascular risk or older age.
Thiazolidinediones Pioglitazone	Funded (or available to prescribe) though sometimes with reservations.	Good insulin sensitivity effects; risk of weight gain, fluid retention; potential adverse effects (heart failure risk, bone fracture risk) must be considered.
Alpha-glucosidase inhibitors Acarbose	Funded or available though less commonly used.	Acts in gut to slow carbohydrate absorption; modest HbA1c lowering; GI side effects often limit tolerance.
DPP-4 Inhibitors ("gliptins") Vildagliptin Sitagliptin Saxagliptin Linagliptin	Vildagliptin is the only one fully funded; others are approved but not funded. t2dm.nzssd.org.nz+2bpac.org.nz+2	Weight-neutral; low risk of hypoglycaemia; useful when metformin is contraindicated or not tolerated; modest HbA1c effect; cost matters when self-funded.
SGLT-2 Inhibitors (“flozins”) Empagliflozin Dapagliflozin	Empagliflozin is funded under special authority criteria; dapagliflozin is approved but not generally funded or subsidised for many patients. t2dm.nzssd.org.nz+2bpac.org.nz+2	Benefits include glucose lowering, cardiovascular & renal protection, weight loss, low hypoglycaemia risk (if not used with insulin/sulfonylureas); risks include genitourinary infections, risk of DKA especially in certain settings; efficacy depends on renal function.
GLP-1 Receptor Agonists Dulaglutide (Trulicity) Liraglutide (Victoza) Semaglutide (Wygovy/Ozempic)	Funded for some patients with T2D under special authority, depending on eligibility (especially empagliflozin & dulaglutide, more recently also liraglutide when criteria met). Access has had supply restrictions. t2dm.nzssd.org.nz+3bpac.org.nz+3Pharmac+3	Strong HbA1c lowering, good weight loss effects, cardiovascular risk reduction; cost higher; injectable; GI side effects common; supply constraints recently causing access restrictions.
Also see Insulins and Type 2 Diabetes

Step-wise approach to Managing Type 2 Diabetes

Step	HbA1c Thresholds / Clinical Triggers	Preferred Medicines (Approved & Funded)	Alternatives / Add-ons (Approved, sometimes unfunded)	Notes / Key Points
Step 1: Initial therapy	HbA1c ≥ 50–55 mmol/mol (after 3 months lifestyle interventions)	Metformin (funded, first-line)	If contraindicated/not tolerated: Vildagliptin (funded), or Acarbose (funded, less used)	Metformin is first-line unless contraindicated. Start low, titrate up. Monitor renal function and GI tolerance.
Step 2: Dual therapy	HbA1c remains > 53–55 mmol/mol after metformin	Add Sulfonylurea (e.g. gliclazide, funded) OR add SGLT-2 inhibitor (empagliflozin, funded under special authority)	Pioglitazone (funded), DPP-4 inhibitors (other than vildagliptin are unfunded)	Empagliflozin now preferred for many with CVD, renal disease, or Māori/Pacific background (equity criteria). Sulfonylureas cheaper but risk hypoglycaemia + weight gain.
Step 3: Triple therapy	HbA1c above target despite dual therapy	Metformin + Empagliflozin + Sulfonylurea (all funded) OR substitute/add GLP-1 receptor agonist (e.g. dulaglutide, liraglutide funded under criteria)	Pioglitazone or unfunded semaglutide (Ozempic) if self-funded	GLP-1 RAs useful where weight loss is desired, or in high cardiovascular risk. Funding requires criteria (see below).
Step 4: Insulin initiation	HbA1c persistently > 64–70 mmol/mol despite oral/GLP-1 therapy	Basal insulin (funded, e.g. insulin glargine, detemir, NPH) ± continue metformin	Premixed insulin (funded), basal-bolus regimens (funded)	Insulin essential for many with long diabetes duration. Risks: weight gain, hypoglycaemia. Support with diabetes nurse specialists essential.
Step 5: Intensification	Ongoing poor control or complex needs	Basal-bolus insulin or Ryzodeg (degludec/aspart premix) (funded from May 2025)	Add GLP-1 RA if not already used (funded under criteria); SGLT-2 for cardiorenal benefit	Stepwise escalation; consider referral to specialist care, multidisciplinary support, continuous glucose monitoring (if available/self-funded).