Skip to Main Content
Table 1—

Summary of antidiabetic interventions as monotherapy

InterventionsExpected decrease in A1C (%)AdvantagesDisadvantages
Step 1: initial    
    Lifestyle to decrease weight     and increase activity 1–2 Low cost, many benefits Fails for most in 1st year 
    Metformin 1.5 Weight neutral, inexpensive GI side effects, rare lactic acidosis 
Step 2: additional therapy    
    Insulin 1.5–2.5 No dose limit, inexpensive, improved lipid profile Injections, monitoring, hypoglycemia, weight gain 
    Sulfonylureas 1.5 Inexpensive Weight gain, hypoglycemia* 
    TZDs 0.5–1.4 Improved lipid profile Fluid retention, weight gain, expensive 
Other drugs    
    α-Glucosidase inhibitors 0.5–0.8 Weight neutral Frequent GI side effects, three times/day dosing, expensive 
    Exenatide 0.5–1.0 Weight loss Injections, frequent GI side effects, expensive, little experience 
    Glinides 1–1.5† Short duration Three times/day dosing, expensive 
    Pramlintide 0.5–1.0 Weight loss Injections, three times/day dosing, frequent GI side effects, expensive, little experience 
InterventionsExpected decrease in A1C (%)AdvantagesDisadvantages
Step 1: initial    
    Lifestyle to decrease weight     and increase activity 1–2 Low cost, many benefits Fails for most in 1st year 
    Metformin 1.5 Weight neutral, inexpensive GI side effects, rare lactic acidosis 
Step 2: additional therapy    
    Insulin 1.5–2.5 No dose limit, inexpensive, improved lipid profile Injections, monitoring, hypoglycemia, weight gain 
    Sulfonylureas 1.5 Inexpensive Weight gain, hypoglycemia* 
    TZDs 0.5–1.4 Improved lipid profile Fluid retention, weight gain, expensive 
Other drugs    
    α-Glucosidase inhibitors 0.5–0.8 Weight neutral Frequent GI side effects, three times/day dosing, expensive 
    Exenatide 0.5–1.0 Weight loss Injections, frequent GI side effects, expensive, little experience 
    Glinides 1–1.5† Short duration Three times/day dosing, expensive 
    Pramlintide 0.5–1.0 Weight loss Injections, three times/day dosing, frequent GI side effects, expensive, little experience 
*

Severe hypoglycemia is relatively infrequent with sulfonylurea therapy. The longer-acting agents (e.g. chlorpropamide, glyburide [glibenclamide], and sustained-release glipizide) are more likely to cause hypoglycemia than glipizide, glimepiride, and gliclazide. †Repaglinide is more effective at lowering A1C than nateglinide. GI, gastrointestinal.

Close Modal

or Create an Account

Close Modal
Close Modal