Summary of antidiabetic interventions as monotherapy
| Interventions . | Expected decrease in A1C (%) . | Advantages . | Disadvantages . |
|---|---|---|---|
| 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 |
| Interventions . | Expected decrease in A1C (%) . | Advantages . | Disadvantages . |
|---|---|---|---|
| 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.