HbA1c reduction is maximum with use of
Mechanism of ActionExamplesHbA Reduction (%)Agent-Specific AdvantagesAgent-Specific DisadvantagesContraindicationsOralBiguanides|Hepatic glucose productionMetformin1-2Weight neutral, do not cause hypoglycemia, inexpensive, extensive experience, |CV eventsDiarrhea, nausea, lactic acidosisSerum creatinine> 15 mg/dL (men)>1.4 mg/dL (women)(see text), CHF, radio graphic contrast studies,hospitalized patients,acidosisRenal/liver diseasea-Glucosidase inhibitors|GI glucose absorptionAcarbose, miglitol, voglibose0.5-0.8Reduce postprandial glycemiaGI flatulence, liver function testsRenal/liver diseaseDipeptidyl peptidase IV inhibitorsProlong endogenous GLP-1 actionAlogliptin, Linagliptin, Gemigliptin, linagliptin, saxagliptin,sitagliptin, teneligliptin, vildagliptin0.5-0.8Well tolerated, donot cause hypoglycemia Reduced dose with renal disease; one associated with increase hea fail pure risk; possible association with ACE inhibitor-induced angioedemaInsulin secretagogues:Sulfonylureas|Insulin secretionGlibornuride, gliclazide, glimepiride,glipizide, gliquidone,glyburide,glyclopyramide1-2Sho onset of action, lower postprandial glucose, inexpensiveHypoglycemia, weight gainRenal/liver diseaseInsulin secretagogues:Nonsulfonylureas|Insulin secretionNateglinide, repaglinide, mitiglinide0.5-1.0Sho onset of action, lower postprandial glucoseHypoglycemiaRenal/liver diseaseSodium-glucose cotranspoer 2 inhibitors|Urinary glucose excretionCanagliflozin,dapagliflozin,empagliflozin0.5-1.0Insulin secretion and action independentUrinary and vaginal infections, dehydration, exacerbate tendency to hyperkalemiaLimited clinical experience; moderate renal insufficiencyThiazolidinediones|Insulin resistance,|glucose utilizationRosiglitazone, pioglitazone0.5-1.4Lower insulin requirementsPeripheral edema,CHF, weight gain,fractures, macularedemaCHF, liver disease Ref: Harrison 19e pg: 2414
Metformin
Anagliptin
Voglibose
Rosiglitazone
Endocrinology