Oral diabetic medication classes
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| Biguanide | decreases hepatic glucose production, decreases intestinal absorption of glucose, and improves insulin sensitivity | * B12 Deficiency, GI Upset, Black Box warning: Lactic acidosis | Metformin | 1.5%
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| Alpha-Glucosidase Inhibitor | Inhibit pancreatic alpha-amylase and alpha-glucosidase, block carbohydrate hydrolysis to glucose, to decrease postprandial blood glucose | Administer with food, Contraindicated in cirrhosis, IBD, and intestinal obstruction | Acarbose, Miglitol | 0.5-0.8%
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| Thiazolidinediones | Peroxisome proliferator-activated receptor gamma activator, which improves insulin sensitivity | Increased risk for bladder cancer, Contraindicated in Heart Failure | Rosiglitazone, Pioglitazone | 0.5-1.5%
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| DiPeptidyl Peptidase4 Inhibitor (DPP-4) | Prolong the active incretin levels of GLP-1 and GIP (decreases glucagon release, increase insulin release, and slow gastric emptying) | May cause Pancreatitis, FDA warning for Saxagliptin and Alogliptin for increase risk of heart failure | Sitagliptin, Saxagliptin, Linagliptin, Alogliptin | 0.5-1%
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| Sodium-Glucose Co-transporter 2 inhibitor (SGLT 2) | Decreases reabsorption of filtered glucose from proximal tubule, increasing glucose excretion in urine | UTI’s common with this class, FDA warning of increased risk for AKI and Euglycemic DKA | Canagliflozin, Dapagliflozin, Empagliflozin | 0.5-0.8%
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| Sulfonylureas | Stimulate insulin release for pancreatic beta cells | Don’t use in Sulfa Allergy, Watch for Hypoglycemia | Glyburide, Glipizide, Glimepiride | 1-2%
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| Meglitinides | In presence of glucose, stimulate insulin release from pancreatic beta cells | Administer 15 to 30 minutes before meals, May cause weight gain | Repaglinide, Nateglinide | 0.5-1.5%
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