Table 1.
Drug | Cardiovascular benefits | Significant side effects |
---|---|---|
Metformin | Indirect via maintaining glycaemic control without hypoglycaemia (does not promote insulin release); improved lipoprotein metabolism; direct/indirect protection of endothelial/vascular function; weight neutral/weight reduction | Lactic acidosis, very rareGI, minor |
Sulfonylureas | Enhanced insulin release; reduction of hyperglycaemia | Hypoglycaemia |
Increased cardiovascular risk | ||
Thiazolidinediones | Enhanced sensitivity to insulin, reduced hepatic gluconeogenesis, pleiotropic actions to reduce inflammation, fat redistribution to subcutaneous sites and reduction in lipotoxicity; reduction in BP | Weight gain, oedema, bone fractures, cardiovascular risk? Cancer? |
Glitazars | Insufficient data regarding relative risk | Cardiovascular risk (drugs withdrawn) |
Incretins | Promote insulin release, pleiotropic protective effects on pancreatic β cells, improved endothelial function | GI, nausea, pancreatitis, pancreatic cancer? |
DPP-4 inhibitors | Enhance insulin release via GLP-1 thereby reduce blood glucose and glucagon, direct and indirect effects on endothelium | Headache, nausea, hypersensitivity,Unknown effects due to nonspecificity of DPP-4 inhibition. |
α-Glucosidase inhibitors | Slow postprandial increases in blood glucose, weight loss, lower triglycerides | GI |
SGLT2 inhibitors | Improved insulin sensitivity, reduced blood pressure | Polyuria, restrict use in renal insufficiency; lack of information as only recently introduced |
Insulin | Improved glucose disposal, improved blood flow; anti-inflammatory action (?) | Hypoglycaemia; promotes cardiac hypertrophy, increase in all-cause mortality? Cancer? |
BP, blood pressure; DPP-4, dipeptidyl peptidase 4; GI, gastrointestinal; GLP-1, glucagon-like peptide 1; SGLT2, sodium glucose cotransporter 2.