Diabetes Medication Comparison Table

I definitely get some questions from students and pharmacists preparing for certification exams.  I wanted to put together this Diabetes Medication Comparison Table that highlights really important stuff that you need to remember.

Drug/Class Primary Mechanism of Action Advantages Disadvantages
Metformin (Biguanides) Reduces liver glucose production Weight loss

Inexpensive

First line

Low risk of hypoglycemia

Avoid in significant CKD

GI side effects

Low B12

frequent dosing (non-IR)

Sulfonylureas Stimulates insulin release from the pancreas Inexpensive

XL products so can dose many once daily

Hypoglycemia risk

Weight gain

DPP-4 Inhibitors Increases endogenous incretin activity Weight neutral/wt loss

once daily dosing in most situations

low risk of hypoglycemia

Cost

Slight pancreatitis risk

TZD’s Increases glucose transport into muscle

 

Once daily dosing

Relatively inexpensive

Weight gain

Edema

CHF exacerbation risk

Potential association with bladder cancer, osteoporosis

SGLT-2 Increases urinary excretion of glucose Wt. loss

Slightly lower BP (good or bad)

Reduction in CVD risk (empagliflozin)

Cost

Increase risk of Urinary Tract Infections

Electrolyte imbalances

GLP-1 Incretin mimetic (promotes fullness, potentiates weight loss) Weight loss

CVD risk reduction (Liraglutide)

Cost

Injection

Avoid in thyroid tumor history

Nausea

Pancreatitis

Hopefully this diabetes comparison table is helpful for you. This isn’t all inclusive, but I think gives you a good sense of what to think about clinically when selecting medications for Type 2 diabetes.

If you have any additions you feel should be added/altered, please feel free to leave a comment, we’re all in this together!

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9 Comments

  1. Ubong Ekperikpe

    You didn’t talk about the Amylin analogues

    Reply
    • Eric Christianson

      That’s a good point, I didn’t include them because it has been a VERY long time since I’ve seen them used. Tried to include the medications I see utilized the most often. – thanks for the comment! Eric

      Reply
  2. Misty Pinkerton

    I know that SUs are typically not recommended in patients who’ve had diabetes for >5-10 years since they stimulate insulin release and by that point in diabetes, those patients have minimal-no beta cell function. What about the DPP-4 inhibitors and GLP-1 agonists that also stimulate insulin release to some extent? Would these still be beneficial in longstanding diabetes since they have other mechanisms?

    Reply
  3. WendyFletchNP

    You forgot to say that blocking intestinal absorption of glucose is another effect of Metformin, which is why taking with food is helpful.

    Reply
  4. Yali Brennan

    Re: Misty’s comment. I do see lots SU used in elderly and am wondering how often that MD checks for c-peptide for any residual insulin production before deciding on SU vs other agents. For DPP-4 and GLP-1, that is an interesting point! But I think in a true type II pt, there is probably always a tiny bit of insulin available, even in super resistant patient so it wont’ be an issue for insulin stimulation vs those drugs (SU/DPP-4/GLP1) really aren’t for type I DM since they have absolutely no insulin endogenously. Any comments from other? Thanks

    Reply
  5. Abdul

    Dear sir

    I need to download this table.can you please share downloadable version?

    Reply
    • Eric Christianson

      Sorry I don’t at this time!

      Reply
  6. Abdul Fatah

    Dear sir
    We need to download Diabetes Medicine.Can you please share in Pdf to get download

    Reply

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Written By Eric Christianson

January 17, 2018

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