Six types of oral medicines (and 12 individual drugs) are now available to help the 25.8 million people in the U.S. with type 2 diabetes control their blood sugar when diet and lifestyle changes are not enough. Our evaluation of these medicines found the following:

• Newer drugs are no better. Two drugs from a class called the sulfonylureas and a drug named metformin have been around for more than a decade and work just as well as newer medicines. Indeed, several of the newer drugs, such as Januvia and Onglyza, 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' safety and 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 more than one diabetes drug is sometimes necessary. Many people with diabetes do not get enough blood sugar control from one medicine. Two or more may be necessary. However, taking more than one diabetes drug raises the risk of adverse effects and increases costs.

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

• Metformin and Metformin Sustained Release — alone or with glipizide or glimepiride
• Glipizide and Glipizide Sustained Release — alone or with metformin
• Glimepiride — alone or with metformin

These medicines are available as low-cost generics, costing from $10 to $60 a month. 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.

This report was updated in June 2011.

Note: If the price box contains a , that indicates the dose of that drug is available for a low monthly cost through programs offered by large chain stores. For example, Kroger, Sam's Club, Target, and Walmart offer a month's supply of selected generic drugs for $4 or a three-month supply for $10. Other chain stores, such as Costco, CVS, Kmart, and Walgreens, offer similar programs. Some programs have restrictions or membership fees, so check the details carefully for restrictions and to make sure your drug is covered.