Table 8.

Summary of glucose-lowering interventions [87]

Intervention	Expected decrease in hemoglobin A1c with monotherapy (%)	Advantages	Disadvantages
Lifestyle to decrease weight and increase activity	1.0–2.0	Broad benefits
Insulin	1.5–3.5	No dose limit, rapidly effective, improved lipid profile	One to four injections daily, monitoring, weight gain, hypoglycemia, analogues are expensive
Metformin	1.0–2.0	Modest weight loss	GI side effects, contraindicated with renal insufficiency
Sulfonylureas	1.0–2.0	Rapidly effective	Weight gain, hypoglycemia (especially with glibenclamide or chlorpropamide)
TZDs	0.5–1.4	Improved lipid profile (pioglitazone)	Fluid retention, CHF, weight gain, bone fractures, expensive,
GLP-1 analogs	0.5–1.0	Weight loss	Given by injection, frequent GI side effects, long-term safety not established, expensive
Other therapy
α-Glucosidase inhibitors	0.5–0.8	Weight neutral	Frequent GI side effects, 3 times per day dosing, expensive
Glinides	0.5–1.5a	Rapidly effective	Weight gain, 3 times per day dosing, hypoglycemia, expensive
Amylin Analogs	0.5–1.0	Weight loss	Three injections daily, frequent GI side effects, long-term safety not established, expensive
DPP-4 inhibitors	0.5–0.8	Weight neutral	Long-term safety not established, expensive
Emerging therapy
Colsevelam	0.5–1	Antilipid properties	GI side effects
Ranolazine	0.6	No hypoglycemia, useful in angina
Salsalate	_	Anti-inflammatory
SGLT2 blockers	_
Bromocriptine	0.6.	Useful in parkinsonism

^aRepaglinide more effective in lowering hemoglobin A_1c level than nateglinide. CHF indicates congestive heart failure; GI, gastrointestinal.