Table 1

Classes of oral antihyperglycemic medications for patients with type 2 diabetes

ClassMedicationMechanismEffect on body weightBenefitAdverse effect
Biguanide

  • Metformin.

Inhibits hepatic glucose production.Mild weight loss.Reduces MI by 39% and coronary deaths by 50%.Lactic acidosis.
Sulfonylurea

  • Glyburide.

  • Glipizide.

  • Glimepiride.

Increases insulin secretion.Weight gain.Very capable of lowering serum glucose.High risk of hypoglycemia and increased cardiovascular disease risk.
Meglitinide

  • Repaglinide.

  • Nateglinide.

Glucose-dependent increase in insulin secretion.Weight gain.Very capable of lowering serum glucose, with less risk of hypoglycemia as sulfonylurea.Risk of hypoglycemia effected by inhibitors of CYP3A4 or CYP2C8 in the liver.
Thiazolidinediones

  • Rosiglitazone.

  • Pioglitazone.

Insulin sensitizer.Weight gain.Minimal risk of hypoglycemia.Heart failure, pioglitazone associated with bladder cancer, and fractures.
Alpha-glucosidase inhibitors

  • Acarbose.

  • Miglitol.

  • Voglibose.

Decrease metabolism and absorption of intestinal polysaccharides.Mild weight loss.Mild decrease in hemoglobin A1c.Flatulence, abdominal discomfort, and diarrhea, and transaminitis.
Dipeptidyl peptidase-4 inhibitors

  • Alogliptin.

  • Linagliptin.

  • Sitagliptin.

  • Saxagliptin.

  • Vildagliptin.

Inhibit degradation of glucagon-like peptide.Neutral.Decrease postprandial triglycerides.Pancreatitis and upper respiratory tract infection.
Sodium-glucose cotransporter-2 inhibitors

  • Canagliflozin.

  • Dapagliflozin.

  • Empagliflozin.

  • Ertugliflozin.

Glucosuria due to blocking (90%) of glucose reabsorption in renal PCT; insulin-independent mechanism of action.Weight loss.Reduce sodium and uric acid absorption, reduce systolic blood pressure, and reduce renal failure progression.Euglycemic ketoacidosis, fractures, and genital mycosis.
Glucagon-like peptide 1 (GLP-1) receptor agonists

  • Semaglutide.

  • Liraglutide.

  • Exenatide.

  • Dulaglutide.

Activate GLP-1 receptor, increased insulin and decreased glucagon secretion, delayed gastric emptying, and increased satiety.Weight loss.Cardiovascular risk reduction.Nausea, vomiting, pancreatitis, and C cell tumor of the thyroid (contraindicated in MEN type 2).

  • CYP, cytochrome P450; MEN, multiple endocrine neoplasm; MI, myocardial infarction; PCT, proximal convoluted tubules.