Table 1.

Drugs used for the treatment of diabetes: cardiovascular benefits and significant side effects.

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Glitazars	Insufficient data regarding relative risk	Cardiovascular risk (drugs withdrawn)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.