Table 1.

Choosing drug class for type 2 diabetes

Drug class	Glucose efficacy	Effect on weight	Risk of hypoglycaemia	Route of administration	Cost	Ideal candidates for use
Metformin	High	Neutral	No	Oral	Low	Newly diagnosed, especially in the absence of atherosclerotic cardiovascular disease, heart failure, or chronic kidney disease
SGLT2i	Intermediate to high	Loss (intermediate)	No	Oral	High	Established or high risk of atherosclerotic cardiovascular disease Heart failure Chronic kidney disease
GLP1RA	High	Loss (intermediate to very high)	No	Subcutaneous (oral semaglutide)	High	Established or high risk of atherosclerotic cardiovascular disease Chronic kidney disease (after SGLT2is) Non-alcoholic steatohepatitis or non-alcoholic fatty liver disease Overweight or obesity
GIP-GLP1RA	High	Loss (very high)	No	Subcutaneous	High	Overweight or obesity
DPP4i	Intermediate	Neutral	No	Oral	High	Older adults or others that require easy administration and high tolerability
Sulfonylurea	High	Gain	Yes	Oral	Low	Those with cost or access barriers, especially in the absence of atherosclerotic cardiovascular disease, heart failure, chronic kidney disease, or overweight or obesity
Thiazolidinedione	High	Gain	No	Oral	Low	Those with cost or access barriers, especially in the absence of heart failure, chronic kidney disease, or overweight or obesity Non-alcoholic steatohepatitis or non-alcoholic fatty liver disease History of stroke/TIA

GIP=glucose dependent insulinotropic polypeptide; GLP1RA=glucagon-like peptide 1 receptor agonist; SGLT2i=sodium-glucose cotransporter 2 inhibitor; DPP4i=dipeptidyl peptidase 4 inhibitor.