. 2023 Jun 30;12(13):4431. doi: 10.3390/jcm12134431

Table 2.

Antihyperglycemic agents and their effect on weight [16,17,19,81,83].

Drug Class	Mechanism of Action	Drug Sub-Class		Drugs	Weight Change	HbA1c Decrease [mmol/mol]	Cost
biguanide	↑ insulin sensitivity ↓ hepatic glucose production			metformin (conventional or extended-release)	NC	10.9	$
incretin	↑ satiety (only GLP1-RA), ↑ glucose-dependent insulin secretion ↓ stomach emptying ↓ glucagon secretion		GLP1 receptor agonist	short-acting: exenatide, lixisenatide, liraglutide ^† long-acting: dulaglutide, exenatide extended-release, semaglutide ^†	↓ 1.1–4.4 kg	6.6–15.3	$$$$
incretin			DPP4 inhibitor	sitagliptin, vildagliptin, saxagliptin, linagliptin, alogliptin	NC	5.5–7.6	$$$
SGLT2 inhibitor	↓ renal glucose resorption			canagliflozin, dapagliflozin, empagliflozin, ertugliflozin	↓ 2.0–3.0 kg	5.5–7.6	$$$
α-glucosidase inhibitor	↓ carbohydrate digestion and absorption (↓ action of α-glucosidase and α-amylase)			acarbose, miglitol	NC	7.6–8.7	$$
insulin	direct substitution of endogenous insulin action	rapid-acting		aspart (conventional and fast-acting), glulisine, lispro	↑ *	≥ 9.8 *	$–$$$$ *
		intermediate-acting		human NPH
		long-acting		degludec, detemir, glargine
insulin + GLP1-RA	(see GLP1-RA and insulin sections)			degludec/liraglutide, glargine/lixisenatide	NC	ND	$$$$
insulin secretagogue	↑ insulin secretion (glucose-independent)	sulfonylurea		glibenclamide (glyburide), glipizide, gliclazide, glimepiride	↑ 1.2–3.2 kg	6.6–13.1	$
insulin secretagogue	↑ insulin secretion (glucose-independent)	meglitinide		repaglinide, nateglinide	↑ 1.4–3.3 kg	7.6–12.0	$$
TZD	↑ insulin sensitivity (activation of PPAR-γ receptors)			pioglitazone, rosiglitazone	↑ 2.0–2.5 kg	7.6–9.8	$$$

NPH—neutral protamine Hagedorn; PPAR-γ—peroxisome proliferator-activated receptor-gamma; TZD—thiazolidinedione; NC—no change; ND—no data; beneficial effect on body weight highlighted in green; neutral effect on body weight highlighted in yellow; adverse effect on body weight highlighted in red. ^† Liraglutide and semaglutide are the only antihyperglycemic drugs approved for the pharmacotherapy of obesity; * drug- and dose-dependent. The number of $ symbols correspond to the cost of the drugs; ↑ = an increase, ↓ = a decrease.