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In the management of type 2 diabetes, the treatment approach often involves starting with lifestyle modifications, such as diet and exercise, along with a first-line medication, such as metformin, to help control blood sugar levels. If blood sugar levels remain uncontrolled despite initial treatment, healthcare providers may consider adding second and third-line medications to the treatment plan. Here are some possible second and third-line drug options: 1. Sulfonylureas. examples are glipizide and glyburide. These medications stimulate the pancreas to release more insulin, which helps lower blood sugar levels. 2. Dipeptidyl Peptidase-4 (DPP-4) Inhibitors. Examples are sitagliptin and saxagliptin. DPP-4 inhibitors work by increasing the levels of incretin hormones, which stimulate insulin release and reduce glucagon production. 3. Glucagon-Like Peptide-1 (GLP-1) Receptor Agonists. examples are liraglutide and exenatide. GLP-1 receptor agonists stimulate insulin secretion, suppress glucagon release, slow gastric emptying, and promote satisfy. They generally have a lower risk of causing hypoglycemia and well-tolerated in patients with peptic ulcer disease 4. Sodium-Glucose Co-Transporter 2 (SGLT2) Inhibitors. Examples are canagliflozin, dapagliflozin. SGLT2 inhibitors work by blocking glucose reabsorption in the kidneys, leading to increased glucose excretion in urine. They also have cardiovascular benefits and may promote weight loss. 5. Thiazolidinediones (TZDs).examples are Pioglitazone , rosiglitazone. They improve insulin sensitivity in peripheral tissues, such as muscle, fat and liver cells. 6. Alpha-Glucosidase Inhibitors. Examples are acarbose, miglitol . they slow down the digestion and absorption of carbohydrates in the intestines, which helps to control post-meal blood sugar