Table 9. Effects of Diabetes Drug Actiona.
| Met | GLP1RA | SGLT2I | DPP4I | TZD | AGI | Coles | BCR-QR | SU/Glinide | Insulin | Pram | |
|---|---|---|---|---|---|---|---|---|---|---|---|
| FPG lowering | Moderate |
Mild to
moderate b |
Moderate | Mild | Moderate | Neutral | Mild | Neutral |
SU: moderate Glinide: mild |
Moderate to marked (basal insulin or premixed) |
Mild |
| PPG lowering | Mild |
Moderate to
marked |
Mild | Moderate | Mild | Moderate | Mild | Mild | Moderate |
Moderate to marked (short/ rapid-acting insulin or premixed) |
Moderate to
marked |
| NAFLD benefit | Mild | Mild | Neutral | Neutral | Moderate | Neutral | Neutral | Neutral | Neutral | Neutral | Neutral |
| Hypoglycemia | Neutral | Neutral | Neutral | Neutral | Neutral | Neutral | Neutral | Neutral |
SU: moderate to
severe Glinide: mild to moderate |
Moderate to severe,
especially with short/rapid-acting or premixed |
Neutral |
| Weight | Slight loss | Loss | Loss | Neutral | Gain | Neutral | Neutral | Neutral | Gain | Gain | Loss |
| Renal impairment/ GU |
Contraindicated
in stage 3B, 4, 5 CKD |
Exenatide
contraindicated CrCl <30 mg/ mL |
GU
infection risk |
Dose adjustment may be necessary (except linagliptin) |
May
worsen fluid retention |
Neutral | Neutral | Neutral |
Increased
hypoglycemia risk |
Increased risks of
hypoglycemia and fluid retention |
Neutral |
| GI adverse effects |
Moderate |
Moderate
(caution in PIs about pancreatitis) |
Neutral | Neutral (caution in PIs about pancreatitis) |
Neutral | Moderate | Mild | Moderate | Neutral | Neutral | Moderate |
| CHF | Neutral | Neutral | Neutral | Neutral (caution: possibly increased CHF hospitalization risk in CV safety trial) |
Moderate | Neutral | Neutral | Neutral | Neutral | Neutral | Neutral |
| CVD | Possible benefit | Neutral | Neutral | Neutral | Neutral | Neutral | Neutral | Safe | ? | Neutral | Neutral |
| Bone | Neutral | Neutral | Bone loss | Neutral |
Moderate
bone loss |
Neutral | Neutral | Neutral | Neutral | Neutral | Neutral |
Abbreviations: AGI = α-glucosidase inhibitors; BCR-QR = bromocriptine quick release; CHF = congestive heart failure; CKD = chronic kidney disease; Coles = colesevelam; CrCl = creatinine clearance; CV = cardiovascular; DPP4I = dipeptidyl peptidase 4 inhibitors; FPG = fasting plasma glucose; GI = gastrointestinal; GLP1RA = glucagon-like peptide 1 receptor agonists; GU = genitourinary; Met = metformin; NAFLD = nonalcoholic fatty liver disease; PI = prescribing information; PPG = postprandial glucose; SGLT2I = sodium-glucose cotransporter 2 inhibitors; SU = sulfonylureas; TZD = thiazolidinediones.
Boldface type highlights a benefit or potential benefit; italic type highlights adverse effects.
Mild: albiglutide and exenatide; moderate: dulaglutide, exenatide extended release, and liraglutide.