Table 3.

Differentiating available diabetes therapies¹⁴,¹⁵,²³–²⁸

Antidiabetic agent	Advantages	Disadvantages
Metformin	Weight neutral, inexpensive, oral	GI side effects, rare lactic acidosis
Thiazolidinediones	Improved lipid profile, oral	Fluid retention, weight gain, CHF, may not see reduction in glucose for several weeks, expensive, increased cardiovascular risk
Alpha-glucosidase inhibitors	Weight neutral, oral	Frequent GI side effects, 3 times/day dosing, expensive
Sulfonylureas	Inexpensive, oral	Weight gain, hypoglycemia
Glinides	Short duration	Hypoglycemia, 3 times/day dosing, expensive
DPP-4 inhibitors Saxagliptin Sitagliptin	Weight neutral, less hypoglycemia, oral	Lack of long-term data regarding safety and efficacy
GLP-1 agonists Exenatide Liraglutide	Less hypoglycemia, weight loss	Injections, lack of long-term data on safety and efficacy
Insulin	Inexpensive, no dose limit, improved lipid profile	Injections, monitoring, hypoglycemia, weight gain
Human insulin Regular or short acting Intermediate acting (NPH)	Many physicians still most comfortable with standard insulin therapy	Limited pharmacokinetic/pharmacodynamic features, hypoglycemia, injections, monitoring, weight gain, variability in time-action profile
Insulin analogs Rapid-acting analogs ○ Aspart ○ Lispro ○ Glulisine Long-acting basal analogs ○ Glargine ○ Detemir Premixed analogs ○ Biphasic insulin aspart 70/30 ○ Insulin lispro 75/25 ○ Insulin lispro 50/50	Less hypoglycemia than human insulin, absorption more consistent, less weight gain; rapid- and long-acting formulations, predictable time–action profiles, simplified dosing with premixes	Injections, monitoring
Devices for insulin delivery
• Traditional vial and syringe	Some physicians most comfortable with standard vial and syringe insulin therapy	Can be complicated to administer, not discreet, time consuming, and potential for dosing errors; patients may have needle aversion
• Pen-injection devices	Convenient, discreet, simple, may improve confidence/adherence and reduce insulin-related adverse events, good for patients who have vision or dexterity problems, decreased dosing errors and more accurate dosing	Some patients are averse to injections in any form

Abbreviations: GI, gastrointestinal; CHF, congestive heart failure; DPP-4, dipeptidyl peptidase-4; GLP-1, glucagon-like peptide 1; NPH, neutral protamine Hagedorn.