Summary of oral drug treatments for type 2 diabetes
| Drug | Mean HbA1c reduction | Risk of hypo-glycaemia | Effect on weight | Advantages | Disadvantages |
|---|---|---|---|---|---|
| Metformin | 1.5 — 2% | Low | Neutral (or small weight loss) | · Patient-orientated outcome data for improvement in micro– and macro-vascular disease | · GI disturbance |
| Sulfonylureas Glibenclamide Gliclazide limepiride Glipizide Tolbutamide | 1.5 — 2% | Yes | 1 to 5kg increase | · Rapid response achieved · Patient-orientated outcome data for improvement in microvascular disease | · Risk of hypoglycaemia · Caution in renal and liver impairment · Caution in the elderly · Driving implications · Undetermined cardiovascular risk |
| Pioglitazone | 1 — 1.5% | Low | Increase | · Can be used in renal impairment | · Contraindicated in heart failure · Contraindicated in hepatic impairment · Contraindicated in bladder cancer or uninvestigated macroscopic haematuria · Risk of bone fracture · Caution in macular oedema |
| DPP-4 inhibitors Alogliptin Linagliptin Saxagliptin Sitagliptin Vildagliptin | 0.6 — 0.8% | Low | Neutral | · Generally well tolerated · Can be used in renal impairment · Established cardiovascular safety | · Association with pancreatitis (very rare) · Heart failure reported in people taking alogliptin and saxagliptin |
| SGLT-2 inhibitors Canagliflozin▼ Dapagliflozin▼ Empagliflozin▼ | 1% | Low | Decrease | · Cardioprotective data for empagliflozin · Weight loss · Decrease in blood pressure | · GU infections |