Table 2.
Effectiveness, advantages, and disadvantages of the various strategies employed in the management of DM
| Intervention | Effectiveness (% Decrease in HbAIC) | Advantages | Disadvantages |
|---|---|---|---|
| Lifestyle changes to decrease weight and increase activity | 1.0–2.0 | Broad benefits, as outlined in the text | Transient GI and musculoskeletal discomfort |
| Insulin | 1.5–3.5 | No dose limit, rapidly effective, improves lipid profile | One to four injections daily, monitoring, weight gain, hypoglycemia, analogues are expensive |
| Metformin | 1.0–2.0 | Weight neutral, low hypoglycemia risk | GI side effects, lactic acidosis (rare), contraindicated with renal insufficiency |
| Sulfonylureas | 1.0–2.0 | Rapidly effective | Weight gain, hypoglycemia (especially with glibenclamide or chlorpropamide) |
| Thiazolidinediones | 0.5–1.4 | Improved lipid profile (pioglitazone) | Fluid retention, congestive heart failure, weight gain, bone fractures, expensive |
| DPP-4 inhibitors | 0.5–0.8 | Weight-neutral | Long-term safety not established, expensive |
| GLP-1 analogs | 0.5–1.0 | Weight loss | Given by injection, frequent GI side effects, long-term safety not established, expensive |
| α-glucosidase inhibitors | 0.5–0.8 | Weight-neutral | Frequent GI side effects, three times per day dosing, expensive |
| Glinides | 0.5–1.5 | Rapidly effective | Weight gain, three 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 |
Note: Copyright © 2012. American Diabetes Association. Reproduced from Inzucchi SE, Bergenstal RM, Buse JB et al. American Diabetes Association (ADA); European Association for the Study of Diabetes (EASD). Management of hyperglycemia in type 2 diabetes: a patient-centered approach: position statement of the American Diabetes Association (ADA) and the European Association for the Study of Diabetes (EASD). Diabetes Care. 2012;35(6):1364–1379.14
Abbreviations: DM, diabetes mellitus; DPP-4, dipeptidyl peptidase-4; GI, gastrointestinal; GLP-1, glucagon-like peptide-1; HbA1c, glycated hemoglobin.