education

Effects of different drugs on glycemic control

Treatment	A1c decrease (%)	Advantages	Disadvantages
Well validated core
Lifestyle to decrease weight and increase activity	1.0 - 2.0	Several benefits	None
Metformin	1.0 - 2.0	Weight neutral	Contraindicated in cases of renal failure
Additional therapy Insulin	1.5 - 3.5	No dose limit, rapidly effective, improved lipid profile	One to four injections daily, monitoring, weight gain, hypoglycemia, analogues are expensive
Sulfonylurea	1.0 - 2.0	Rapidly effective	Weight gain, hypoglycemia (especially with glibenclamide or chlorpropamide)
Less validated core
TZDs	0.5 - 1.4	Improved lipid profile (pioglitazone), potential decrease in MI (pioglitazone)	Fluid retention, CHI, weight gain, bone fractures, expensive, potential increase in MI (rosiglitazone)
GLP-1 agonist	0.5 - 1.0	Weight loss	Two injections daily, frequent GI side effects, long-term safety not established, expensive
Glucosidase inhibitor	0.5 - 0.8	Weight neutral	Frequent GI side effects, three times/day dosing, expensive
Pramlintide	0.5 - 1.0	Weight loss	Three injections daily, frequent GI side effects, long-term safety not established, expensive
DPP-4 inhibitor	0.5 - 0.8	Weight neutral	Long-term safety not established, expensive