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Type 2 DM Treatment
Class & Generic | Dosing | MOA | Efficacy & Target | ADRs | Clinical Pearls |
---|---|---|---|---|---|
DPP-4 inhibitors: sitagliptan saxagliptan linagliptan alogliptin | Daily | Inhibits GLP-1 breakdown | <1 Postprandial | HA Nasopharyngitis Peripheral edema Pancreatitis | Take w/ or w/out food High cost C/I: Hx of pancreatitis |
SGLT-2 inhibitors: canagliflozin dapagliflozin empagliflozin | Daily | Increase urinary Glu excretion by blocking reabsorption in proximal convoluted tubule | <1 | Genital mycotic infections UTIs Hypotension Bone Fractures | Increases urination Expensive C/I: severe renal impairment |
GLP-1 agonists: exenatide liraglutide albiglutide dulaglutide | Weekly-BID | Increase insulin secretion; Decrease glucogon secretion; Reduce gastric emptying; Promote satiety | <1 Postprandial | GI Pancreatitis Medullary thyroid tumors | Injectable Expensive Liraglutide indicated for weight loss C/I: Hx of pancreatitis, renal inpairment |
Amylin analog: pramlintide | TID | Decrease glucagon secretion; Slow gastric emptying; Promote satiety | <1 Postprandial | GI HA Hypoglycemia | Administered w/insulin (injectable) Expensive Weight loss C/I: hypoglycemia unawareness, gastroparesis |
Bile Acid Binding Resin: colesevelam | Daily-BID | Unclear; Reduce hepatic gluconeogenesis or intestinal Glu absorption | <1 Postprandial | GI | Expensive C/I: bowel obstruction, TGs >500 |
Dopamine agonist: bromocriptine | Daily | Unclear: Affect circadian activities the reduce caloric intake and storage | <1 Fasting | GI HA DZ | Can decrease antipsychotic effectiveness Expensive C/I: syncopal migraine, breastfeeding, uncontrolled HTM |
Biguanide: metformin | Daily-BID | Decrease hepatic Glu production; Decrease intestinal Glu absorption; Increase insulin sensitivity | >1 Fasting | GI Lactic acidosis (BBW) B12 deficiency | Take w/food for GI Hold 48 hrs for contrast C/I: GFR <30, metabolic acidosis, HF |
Sulfonylureas: glyburide glipizide glimepiride | Daily-BID | Increase insulin secretion | >1 Fasting & postprandial | Hypoglycemia Weight gain | Skip dose if meal is skipped C/I: hypoglycemia unawareness, renal dysfunction, T1DM Glipizide for renal dysfunction |
Meglitinides: repaglinide nateglinide | TID | Increase insulin secretion | ~1 Postprandial | Hypoglycemia Weight gain URTIs | Skip dose if meal is skipped C/I: repaglinide + gemfibrozil, T1DM |
TZDs: pioglitazone rosiglitazone | Daily | Increase insulin sensitivity | >1 Fasting & postprandial | Fluid retention Weight gain Increase lipids Fracture risk Bladder cancer (pioglitazone) | Slow onset C/I: Class III/IV HF, LFTs >3x ULN |
alpha-Glucosidase inhibitors: acarbose miglitol | TID | Slows intestinal carb digestion/absorption | <1 Postprandial | GI | Take w/1st bite of food Use Glu to treat hypoglycemia C/I: IBD, colonic ulcerations, intestinal obstructions, cirrhosis (acarbose) |