Table 2.

Summary of type 2 diabetes medication benefits/risks (1, 23, 24).

	Biguanides	Secretagogues	DPP4is	GLP1RAs	SGLT2i	TZD	Insulin
Agents	Metformin	Sulfonylureas Glyburide Glibenclamide Glipizide Glimperide Gliclazide Megitinides Nateglinide Repaglinide	Sitagliptin Saxagliptin Linagliptin Alogliptin	Exenatide Liraglutide Dulaglutide Lixisenatide Semaglutide	Canagliflozin Dapagliflozin Empagliflozin Ertugliflozin	Pioglitazone Rosiglitazone	Rapid-acting insulin Basal insulins
Mechanism of action	Decreases hepatic gluconeogenesis, decreases intestinal absorption of glucose, improves insulin sensitivity by increasing peripheral glucose uptake	Stimulates pancreatic islet cells which causes an increase in insulin secretion. These drugs are not effective in the absence of functioning beta cells	Dipeptidyl peptisase-4 inhibitor that slows the inactivation of incretin hormones GLP-1 and GIP	Increase GLP-1 which leads to glucose dependent ↑ in insulin & ↓ in glucagon and ↓ glucose. Benefts of delayed gastric emptying and enhanced satiety	Sodium-glucose co-transporter 2 inhibitor that reduces reabsorption of filtered glucose and lowers the renal threshold for glucose thereby increasing urinary glucose excretion	Thiazolidine- dione that enhances insulin sensitivity in adipose tissue, skeletal muscle and liver to decrease plasma glucose, insulin concentrations
Hypoglycemia	Neutral	Moderate-severe (*mild glinide)	Neutral	Neutral	Neutral	Neutral	Moderate to severe
Weight	Slight loss	Gain	Neutral	Loss	Loss	Gain	Gain
Renal/GU	Not for eGFR <30	Hypoglycemic risk	Renal dosing except linagliptin	No exenatide for CrCl <30	Reduce progression of CKD	Neutral	More hypoglycemia risk
GI ADR	Moderate	Neutral	Neutral	Moderate	Neutral	Neutral	Neutral
Cardiac/CHF	Neutral	More CHF risk	Possible with saxagliptan, alogliptan	Possible benefit liraglutide	Reduced risk hospitalization for heart failure	Moderate	More CHF risk
Cardiac/ASCVD	Neutral	Risk↑	Neutral	Benefit liraglutide, semaglutide, dulaglutide, albiglutide	Benefit empagliflozin, canagliflozin	May reduce stroke risk	Neutral
Bone	Neutral	Neutral	Neutral	Neutral	Canagliflozin warning	Moderate fracture risk	Neutral
Ketoacidosis	Neutral	Neutral	Neutral	Neutral	DKA in T2D in stress	Neutral	Neutral

^*Mild with glinide; Mod/severe with sulfonylurea. DPP4is, Dipeptidyl Peptidase 4 Inhibitors; GLP1Ras, Glucagon-like-peptide-1 receptor agonists; SGLT2i, sodium glucose cotransporter 2 inhibitors; TDZ, Thiazolidinediones. ↓, decrease; ↑, increase.