Orals and Non-Insulin Injectables

Class

Meds in class

Physiologic action

Approx. ↓ in A1c

Adverse effects

Other comments

Oral Agents

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

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