TABLE 1.
FDA-Approved Pharmacological Interventions That Target Postprandial Hyperglycemia*
| Agent | Mode of Action | A1C Reduction, % | PPG Reduction, mmol/L (mg/dL) | CV Benefit |
|---|---|---|---|---|
| AGIs | ||||
| Acarbose | Inhibits carbohydrate digestion, delaying absorption | 0.4–0.8 | 4.0 (72) | |
| Miglitol | Inhibits carbohydrate digestion, delaying absorption; enhances GLP-1 activity | 0.2–0.8 | 1.5–3.5 (27–63) | |
| Amylin analogs | ||||
| Pramlintide | Slows gastric emptying; suppresses glucagon activity; increases satiety | 0.6 | 2.0 (36) | |
| Glinides | ||||
| Repaglinide | Stimulates insulin release | 0.6–1.5 | 2.6 (47) | |
| Nateglinide | Stimulates insulin release | 0.5–0.8 | 2.6 (47) | |
| Insulin | ||||
| Rapid-acting | 1.5–2.5 | |||
| SGLT2 inhibitors | ||||
| Canagliflozin | Inhibition of glucose reuptake in the kidney; short-term inhibition of intestinal SLGT1 at higher doses | 0.8–1.0 | 2.4–3.3 (43–59) | ✓ |
| Dapagliflozin | Inhibition of glucose reuptake in the kidney | 0.6–1.0 | 3.6–3.8 (65–68) | |
| Empagliflozin | Inhibition of glucose reuptake in the kidney | 0.7–0.8 | 2.0–2.6 (36–47) | |
| Incretin-based agents | ||||
| GLP-1 receptor agonists | ||||
| Exenatide | Enhances insulin secretion; inhibits glucagon release after eating; delays gastric emptying; promotes satiety | 0.5–1.0† | 3.6 (65) | |
| Short-acting: predominant effect on PPG | ||||
| Long-acting: predominant effect on FPG | ||||
| Liraglutide | Enhances insulin secretion; inhibits glucagon release after eating | 1.0–1.5† | 1.7–2.7 (31–49) | ✓ |
| Predominant effect on FPG | ||||
| Lixisenatide | Enhances insulin secretion; inhibits glucagon release after eating; delays gastric emptying; promotes satiety | 0.5–0.9 | 3.1–5.9 (56–106) | |
| Predominant effect on PPG | ||||
| DPP-4 inhibitors | ||||
| Sitagliptin | Inhibits DPP-4, increasing levels of GLP-1 | 0.6–0.8 | 2.8 (50) | |
| Saxagliptin | Inhibits DPP-4, increasing levels of GLP-1 | 0.6–0.8 | 2.8 (50) | |
| Combination agents | ||||
| iDegLira | Complementary action of basal insulin on FPG and GLP-1 receptor agonist on PPG | 0.8–1.9 | Not reported | |
| iGlarLixi | Complementary action of basal insulin on FPG and GLP-1 receptor agonist on PPG | 1.1–1.6 | 4.7–5.7 (85–103) | |
Adapted from refs. 3, 96, and 97, with additional data from refs. 47–62.
*
Used as monotherapy or in combination with other antidiabetic agents.
†
Assuming starting value ≥8%.