University of Iowa
Department
of Family Medicine
FPInfo: Resources to support patient care
Orals and Non-Insulin Injectables |
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Class |
Meds in class |
Physiologic action |
Approx. ↓ in A1c |
Adverse effects |
Other comments |
|
Oral Agents |
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Biguanides |
Metformin (Glucophage®, Glucophage XR®) |
Decreased hepatic glucose production |
1.5% |
GI (diarrhea), lactic acidosis (rare) |
First line treatment, Do not use if renal impairment |
|
Sulfonylureas |
Glyburide (Diabeta®, Micronase®) Glipizide (Glucotrol®, Glucotrol XL®) Glimepiride (Amaryl®) |
Increased insulin secretion |
1.5% |
Hypoglycemia, weight gain |
Do not preserve β-cell function – efficacy decreases over time |
|
Thiazolidinediones |
Pioglitazone (Actos®) Rosiglitazone (Avandia®) |
Increased insulin sensitivity |
0.5-1.5% |
Weight gain, edema, heart failure |
Meta-analysis showed ↑ MI w/ rosi, ? ↑ bladder cancer with pio |
|
α-Glucosidase inhibitors |
Acarbose (Precose®) Miglitol (Glyset®) |
Decreased digestion and absorption of carbohydrates |
0.5-1% |
GI (gas, bloating, diarrhea) |
Frequent dosing (TID) |
|
Meglitinides (non-sulfonylurea secretagogues) |
Repaglinide (Prandin®) Nateglinide (Starlix®) |
Increased insulin secretion |
1.0% |
Hypoglycemia |
Frequent dosing (TID) |
|
Dopamine agonist |
Bromocriptine (Cycloset®) |
Increased insulin sensitivity |
0.5% |
Nausea, fatigue, dizziness |
↑ cost with modest efficacy |
|
Bile acid sequestrant |
Colesevelam (Welchol®) |
Decreased hepatic glucose production, increased incretin levels |
0.5% |
Constipation, increased triglycerides |
Modest efficacy, pill burden, drug interaction concerns |
|
DPP-4 inhibitors |
Sitagliptin (Januvia®) Saxagliptin (Onglyza®) Linagliptin (Tradjenta®) Alogliptin (Nesina®) |
Increased insulin secretion, decreased glucagon secretion |
0.5-1% |
Generally well tolerated, nasopharyngitis, ?pancreatitis |
Decrease dose of SU or insulin if combined |
|
SGLT 2 inhibitors |
Canagliflozin (Invokana®) Dapagliflozin (Farxiga®) Empagliflozin (Jardiance®) |
Increased urinary glucose excretion by blocking reabsorption of filtered glucose |
0.5-1% |
Genital fungal infections, UTI, polyuria |
Weight loss |
|
Non-insulin Injectable Agents |
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GLP1 agonists |
Exenatide (Byetta®) Liraglutide (Victoza®) Exenatide extended release (Bydureon®) Albiglutide (Tanzeum®) Dulaglutide (Trulicity®) |
Increased insulin secretion, decreased glucagon, delayed gastric emptying, increased satiety |
0.5-1.5% |
GI (nausea), ?pancreatitis |
Injectable only, weight loss |
|
Amylin analog |
Pramlintide (Symlin®) |
Decreased glucagon, delayed gastric emptying, increased satiety |
0.5-1% |
GI (nausea, vomiting), hypoglycemia |
Injectable only, frequent dosing (TID), weight loss |
INSULIN for T2DM