Table 1.

Current pharmacological agents for T2D

Class of medication	Representative agents	Mechanism of action	Glycemic efficacy (% HbAlc reduction)	CVD risks and benefits	Side effects
Biguanide	Metformin	Insulin sensitizer; ↓. HGP and gluconeogenesis	↓ 1–2%	↓ CVD risk factors; ↓ MI and coronary deaths	GI and lactic acidosis
Sulfonylureas	Glimepiride, glipizide, glyburide	↑ Insulin secretion	↓ 1–2%	↑ CVD risk	Hypoglycemia
SGLT2 inhibitors	Canagliflozin, Dapagliflozin, Empagliflozin	↓ Glucosuria; ↓ glucotoxicity	↓ 0.5–0.7%	↓ Blood pressure; improved lipid profile	Ketoacidosis, genital mycosis, bone fractures
Incretin mimetics	GIP, GLP-1 (Liraglutide, Exenatide, Dulaglutide)	↑ Insulin secretion; ↓ glucagon secretion; delayed gastric emptying; ↑ satiety	↓ 0.5–1.5%	↓ CVD risk	Nausea, vomiting, pancreatitis
TZDs	Rosiglitazone, pioglitazone	Insulin sensitizer; ↑ adipocyte function; ↓ ectopic lipid accumulation; ↑ β-cell function	↓ 0.5–1.4%	↑ CVD risk	Weight gain, bladder cancer, bone fractures
α-Glucosidase inhibitors	Acarbose, voglibose, miglitol	↓ Carbohydrate absorption	↓ 0.8%	↓ CVD risk	Diarrhea, abdominal pain, nausea, vomiting
Insulin	Short acting: humulin R, novolin R Intermediate acting: isophane Long acting: Lantus, Levemir, Tresiba Rapid acting: Lispro, Aspart, Apidra	↓ HGP; ↑ glucose uptake	↓ 1–2.5%	Neutral	Hypoglycemia, weight gain

Abbreviations: CVD, cardiovascular disease; GI, gastrointestinal; GIP, gastric inhibitory polypeptide; GLP-1, glucagon-like peptide 1; HbA1c, hemoglobin A1c; HGP, hepatic glucose production; MI, myocardial infarction; SGLT2, sodium–glucose cotransporter; T2D, type 2 diabetes; TZD, thiazolidinedione.