DRUG HYPOGLYCEMIA RISK

~A1C REDUCTI

ON

WEIGHT

CHANGE

ADVANTAGES DISADVANTAGES/ SIDE EFFECTS

METFORMIN

No 1.0 – 2.0%

LOSS Decreased CV events and

mortality; Cost Effective $

GI intolerance ; B12 Def; Lactic Acidosis ; Avoid if

Creat >1.4-1.5

TZD(Actos; Avandia)

No 1.0 – 1.5%

GAIN No hypoglycemiaRaises HDL

Lowers Triglycerides

Weight Gain & Edema; Mod Bone Loss

LDL increase; Heart FailureExtreme caution with heart

disease$$$

DPP -4i(Januvia; Onglyza;

Tradjenta)

No 0.5 – 0.8%

Neutral Weight NeutralNo Hypoglycemia

Potential for Pancreatitis$$$

GLP- 1 RA

(Byetta; Bydureon; Victoza;

Tanzeum)

No 0.5 – 1.0%

LOSS Wt Loss ~2-3kgImproved Beta Cell

Fxn

BID injection(Byetta)Nausea

$$$

SGLT2(Farxiga; Invokana)

No 0.9 – 1.2%

LOSS Complimentary to other agents

including insulinWeight Reduction –

significantLower’s B ~5ptsP

Increased genital mycotic infections & UTI’s ; Avoid in

pt’s with active Bladder Cancer; Volume Depletion

HypotensionElevated Creat and ?LDL

Contraindicated eGFR <30(I) - <60(F)

$$$$

DRUG HYPOGLYCEMIA RISK

~A1C REDUCTI

ON

WEIGHT CHANGE

ADVANTAGES

DISADVANTAGES/ SIDE EFFECTS

Amylin Agonist

(Pramlintide/ Symlin)

YES 0.5 – 0.7% LOSS ~ 1-1.5 Kg wt loss

Reduces insulin

requirements

TID injectionNausea

Hypoglycemia( w/insulin use)$$$

Colesevelam(Welchol)

No 0.5% Neutral Lowers Glucose without

HypoglycemiaLowers LDL

$$$-$$$$GI

Separate dosing to prevent binding

SFU/ GLINIDES(Glipizide/Glucotrol;

Glyburide/Diabeta/ Micronase;

Glimepiride/Amaryl)

YES ~1.5% GAIN Well toleratedCost Effective

$

HypoglycemiaWeight Gain

Meglitineides(Starlix; Prandin)

YES ~1.5% YES Enhanced effects at

meals

HypoglycemiaWt Gain

Freq Dosing (qac)

AGI(Acarbose/Precose;

Miglitol/Glyset)

No 0.5 – 0.8% Neutral Local actionDecrease pp

glucose$$

Gi intoleranceDosing Frequency (TID

Dosing)

Cycloset(Bromocriptine)

No 0.6% Neutral CV SafetyNo

Hypoglycemia

EARLY AM DOSINGNausea; Decreasing eff of

Neuroleptic agents & Psychotic meds; May cause

Ortho Hypotension; Increased somulence; $$$