Table 3 Therapeutic considerations of selected US FDA-approved antidiabetes agents [20, 21, 25, 30–35]
From: Therapies for type 2 diabetes: lowering HbA1c and associated cardiovascular risk factors
Intervention | HbA1c Reduction (%) | Effect on Weight | Effect on Lipids | Effect on Blood Pressure | Safety |
|---|---|---|---|---|---|
Oral | Â | Â | Â | Â | Â |
SFUs | 0.9-2.5 | Increased | Small improvements; mainly in TG | Poorly quantified | Increased risk of hypoglycemia |
Metformin | 1.1-3.0 | Neutral or slightly decreased | Improved | Neutral | Contraindicated in patients with renal insufficiency |
Glinides | 0.4-0.6 | Neutral (poorly quantified) | Poorly quantified | Poorly quantified | Caution in patients with hepatic or renal impairment (nateglinide) |
TZDs | 1.5-1.6 | Increased | Improved HDL and TG | Small improvements | Fluid retention, CHF, bone fractures, potential increase in MI (rosiglitazone) |
DPP-4 inhibitors | 0.8 | Neutral | Poorly quantified | Small improvements in non-diabetics | Long-term safety not established |
α-Glucosidase inhibitors | 0.5-1.0 | Suggested decrease | Poorly quantified | Poorly quantified | Frequent flatulence |
Parenteral | Â | Â | Â | Â | Â |
Insulin | Up to 4.9 | Increased | Improved | Neutral | Increased risk of hypoglycemia |
GLP-1 receptor agonists | 0.8-1.5 | Decreased | Improved | Lowered | Nausea and vomiting; hypoglycemia with sulfonylureas; rare pancreatitis and renal dysfunction; thyroid C-cell tumors in rodents |
Amylin analog | 0.4-0.6 | Slightly decreased | Small improvements | Small improvements | Contraindicated in patients with gastroparesis |