Table 1

Classes of oral antihyperglycemic medications for patients with type 2 diabetes

ClassMedicationMechanismEffect on body weightBenefitAdverse effect
  • Metformin.

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

  • Glipizide.

  • Glimepiride.

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