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How does Januvia work for type 2 diabetes?

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How does it work?Efficacy and side effectsJanuvia and other drugsDietAlternativesStaying healthySummary
Januvia blocks an enzyme called DPP-4 and increases incretin hormones. This action causes your pancreas to create more insulin and your liver to produce less glucagon, lowering blood sugar levels.
Medically reviewed by Alyssa Walton, PharmD
Written by Rashida Ruwa, RN
Updated on

Healthcare professionals often prescribe Januvia for people with type 2 diabetes. It works by inhibiting the dipeptidyl peptidase-4 (DPP-4) enzyme, increasing insulin production, and decreasing glucagon production, which helps improve blood sugar management.

Januvia is generally well-tolerated but may cause mild side effects like upper respiratory tract infections and an upset stomach. Serious side effects are rare but can include pancreatitis and acute kidney failure.

Januvia can effectively lower blood sugar levels within a few days or weeks, and you can take it alongside other medications under the guidance of a healthcare team.

How does Januvia work for type 2 diabetes?

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Januvia works by blocking the activity of the DPP-4 enzyme. This enzyme breaks down incretin hormones in the body, like glucagon-like peptide-1 (GLP-1) and gastric inhibitory peptide (GIP), which help regulate blood sugar levels.

By blocking DPP-4, Januvia increases the levels of GLP-1 and GIP, leading to increased insulin secretion and decreased glucagon secretion. This results in reduced blood sugar levels after meals and fasting in people with type 2 diabetes.

About its efficacy and potential side effects

Experts have demonstrated that Januvia can effectively lower blood sugar levels in people with type 2 diabetes. A 2016 study showed that it can significantly reduce hemoglobin A1c (HbA1c), which is your blood sugar levels over the past 2–3 months, and fasting blood sugar levels.

You take Januvia once each day before or after a meal. Although it acts quickly, it can take a few days to a few weeks to observe its full blood sugar-lowering effects. According to some studies, some people taking Januvia noticed improvements in their blood sugar levels after 18 weeks.

People generally tolerate Januvia well. However, like any medication, it may cause some side effects. The most commonly reported side effects of Januvia include:     

  • headaches
  • upper respiratory tract infection, like the common cold
  • arthralgia (joint pain)
  • urinary tract infection

These side effects are mild and usually resolve on their own within a few days or weeks.

More serious side effects of Januvia are rare but can include:

  • pancreatitis (inflammation of the pancreas)
  • allergic reactions
  • acute kidney failure

While these cases are rare, consider discussing your medical history and any existing kidney conditions with a healthcare professional before starting Januvia treatment. They will closely monitor how you respond to it and ensure its safety and efficacy.

However, seek immediate medical attention if you experience:

  • severe stomach pain
  • persistent nausea or vomiting
  • rash
  • itching
  • swelling

These symptoms can be signs of a more serious condition, such as pancreatitis or an allergic reaction.

Does it work alongside any other medications?

You can take Januvia alone or in combination with other medications for treating type 2 diabetes. Healthcare professionals often prescribe it alongside other oral antidiabetic drugs like metformin or sulfonylureas.

Combining Januvia with other medications can help you achieve better blood sugar management by targeting the different processes involved in regulating glucose. A healthcare professional will determine the most appropriate combination of medications based on your needs and individual factors.

Consider discussing all of your medications, including over-the-counter drugs and supplements, with a healthcare team. They will review your medication list to ensure there are no potential interactions or adverse effects.

Are there any dietary adaptations to follow?

While taking Januvia, there is no need for any specific dietary adaptations. However, it’s important to maintain a balanced diet to help maintain stable blood sugar levels and manage type 2 diabetes effectively.

A healthy diet for people with diabetes typically includes:

  • a variety of fruits
  • nonstarchy vegetables
  • whole grains
  • lean proteins
  • healthy fats

To keep your blood sugar levels within optimal range, medical professionals recommend limiting:

  • sweetened beverages
  • processed foods
  • sugary foods
  • desserts

While taking Januvia, it is important to avoid excessive alcohol consumption, as it can increase the risk of pancreatitis and hypoglycemia (low blood sugar). 

Consider speaking with a healthcare team if you have any concerns or questions about dietary changes while taking Januvia. They can guide you based on your health needs and goals.

What are some alternative medications?

Sometimes, a doctor or healthcare professional may consider alternative medications depending on several factors, like your medical history, potential side effects, and treatment goals.

Some alternatives to Januvia include:

DPP-4 inhibitors

Alternative DPP-4 inhibitors include:


Sulfonylureas stimulate cells in the pancreas, called beta cells, to increase insulin production and reduce the amount of insulin cleared from the body by the liver. This helps lower blood sugar levels.

They include: 

Sulfonylureas effectively lower blood sugar levels but can cause low blood sugar as a possible side effect.


These medications help reduce the amount of glucose the liver produces and improve insulin sensitivity. Commonly prescribed biguanides include:

Metformin is the preferred first-line medication for treating type 2 diabetes due to its effectiveness and low risk of hypoglycemia.

Glucagon-like peptide-1 (GLP-1) receptor agonists

These medications mimic the action of incretin hormones, stimulating insulin secretion and suppressing glucagon release. This leads to lower blood sugar levels. They include:

You can discuss alternative options with a healthcare professional to help determine the appropriate medication for you.

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Working with a healthcare team to keep you healthy

Working with a healthcare team when you have diabetes is important. It usually involves regular visits with doctors, nurses, and dietitians specializing in diabetes management.

These experts can provide you with ongoing care and help you with:

  • monitoring your blood sugar levels
  • adjusting medication dosages if necessary
  • getting proper nutrition
  • developing an exercise routine

By working as a team, you and your healthcare team can optimize treatment plans, manage concerns promptly, and help you maintain blood sugar levels to prevent complications.

This support system is important for a holistic approach to managing diabetes and promoting your overall health and well-being.


Januvia is a medication that belongs to the class of DPP-4 inhibitors. It works by blocking the DPP-4 enzyme, increasing the levels of incretin hormones that help regulate blood sugar levels. You can take Januvia on its own or in combination with other medications for better blood sugar management.

While people usually tolerate the drug well, it may cause mild side effects like a stuffy nose or stomach upset. Serious side effects are rare but can include pancreatitis and allergies.

Alternative medications include other DPP-4 inhibitors, sulfonylureas, biguanides, and GLP-1 RAs. However, a healthcare professional can advise on the appropriate medication and treatment plan. 

Download the free Optum Perks Discount Card to save up to 80% on some prescription medications.

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