Agents Used for Treatment of Type 1 or Type 2 Diabetes Mechanism of Action Examples HbA Reduction (%) Agent-Specific Advantages Agent-Specific Disadvantages Contraindications Oral Biguanides |Hepatic glucose production Metformin 1-2 Weight neutral, do not cause hypoglycemia, inexpensive, extensive experience, |CV events Diarrhea, nausea, lactic acidosis Serum creatinine > 15 mg/dL (men) >1.4 mg/dL (women) (see text), CHF, radio graphic contrast studies, hospitalized patients, acidosis Renal/liver disease a-Glucosidase inhibitors |GI glucose absorption Acarbose, miglitol, voglibose 0.5-0.8 Reduce postprandial glycemia GI flatulence, liver function tests Renal/liver disease Dipeptidyl peptidase IV inhibitors Prolong endogenous GLP-1 action Alogliptin, Linagliptin, Gemigliptin, linagliptin, saxagliptin, sitagliptin, teneligliptin, vildagliptin 0.5-0.8 Well tolerated, do not cause hypoglycemia Reduced dose with renal disease; one associated with increase hea fail pure risk; possible association with ACE inhibitor-induced angioedema Insulin secretagogues: Sulfonylureas |Insulin secretion Glibornuride, gliclazide, glimepiride, glipizide, gliquidone, glyburide, glyclopyramide 1-2 Sho onset of action, lower postprandial glucose, inexpensive Hypoglycemia, weight gain Renal/liver disease Insulin secretagogues: Nonsulfonylureas |Insulin secretion Nateglinide, repaglinide, mitiglinide 0.5-1.0 Sho onset of action, lower postprandial glucose Hypoglycemia Renal/liver disease Sodium-glucose cotranspoer 2 inhibitors |Urinary glucose excretion Canagliflozin, dapagliflozin, empagliflozin 0.5-1.0 Insulin secretion and action indepentant Urinary and vaginal infections, dehydration, exacerbate tendency to hyperkalemia Limited clinical experience; moderate renal insufficiency Thiazolidinediones |Insulin resistance, |glucose utilization Rosiglitazone, pioglitazone 0.5-1.4 Lower insulin requirements Peripheral edema, CHF, weight gain, fractures, macular edema CHF, liver disease Ref: Harrison 19e pg: 2414