Anti-diabetic Medication - Comparison

Comparison

The following table compares some common anti-diabetic agents, generalizing classes, although there may be substantial variation in individual drugs of each class. When the table makes a comparison such as "lower risk" or "more convenient" the comparison is with the other drugs on the table.

Comparison of anti-diabetic medication
agent mechanism advantages disadvantages
Sulfonylurea (glyburide, glimepiride, glipizide) Stimulating insulin production in pancreatic beta cells by inhibiting the KATP channel
  • Fast onset of action
  • No effect on blood pressure
  • No effect on low-density lipoprotein
  • inexpensive
  • lower risk of gastrointestinal problems than with metformin
  • more convenient dosing
  • causes an average of 5-10 pounds weight gain
  • Increased risk of hypoglycemia
  • Glyburide has increases risk of hypoglycemia slightly more as compared with glimepiride and glipizide
  • Higher risk of death compared with metformin
Metformin Acts on liver to cause decrease in insulin resistance
  • not associated with weight gain
  • low risk of hypoglycemia as compared to alternatives
  • Good effect on LDL cholesterol
  • Decreases triglycerides
  • no effect on blood pressure
  • inexpensive
  • increased risk of gastrointestinal problems
  • Contraindicated for people with moderate or severe kidney disease or heart failure because of risk of lactic acidosis
  • increased risk of Vitamin B12 deficiency
  • less convenient dosing
  • Metallic taste
Alpha-glucosidase inhibitor (acarbose, miglitol) Reduces glucose absorbance by acting on small intestine to cause decrease in production of enzymes needed to digest carbohydrates
  • slightly decreased risk of hypoglycemia as compared to sulfonylurea
  • not associated with weight gain
  • decreases triglycerides
  • no effect on cholesterol
  • less effective than most other diabetes pills in decreasing glycated hemoglobin
  • increased risk of GI problems than other diabetes pills except metformin
  • inconvenient dosing
  • expensive
thiazolidinediones (Actos, Avandia) Reduce insulin resistance by activating PPAR-γ in fat and muscle
  • Lower risk of hypoglycemia
  • Slight increase in high-density lipoprotein
  • Actos linked to decreased triglycerides
  • Convenient dosing
  • increased risk of heart failure
  • causes an average of 5-10 pounds weight gain
  • associated with higher risk of edema
  • lassociated with higher risk of anemia
  • increases low-density lipoprotein
  • Avandia linked to increased triglycerides and risk of heart attack
  • Actos linked to increased risk of bladder cancer
  • slower onset of action
  • requires monitoring for hepatoxicity
  • associated with increased risk of limb fractures
  • expensive

Most anti-diabetic agents are contraindicated in pregnancy, in which insulin is preferred.

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