Table 1—— Summary of antidiabetic interventions as monotherapy

Interventions Expected decrease in A1C (%) Advantages Disadvantages Step 1: initial     Lifestyle to decrease weight     and increase activity 1–2 Low cost, many benefits Fails for most in 1st year     Metformin 1.5 Weight neutral, inexpensive GI side effects, rare lactic acidosis Step 2: additional therapy     Insulin 1.5–2.5 No dose limit, inexpensive, improved lipid profile Injections, monitoring, hypoglycemia, weight gain     Sulfonylureas 1.5 Inexpensive Weight gain, hypoglycemia*     TZDs 0.5–1.4 Improved lipid profile Fluid retention, weight gain, expensive Other drugs     -Glucosidase inhibitors 0.5–0.8 Weight neutral Frequent GI side effects, three times/day dosing, expensive     Exenatide 0.5–1.0 Weight loss Injections, frequent GI side effects, expensive, little experience     Glinides 1–1.5 Short duration Three times/day dosing, expensive     Pramlintide 0.5–1.0 Weight loss Injections, three times/day dosing, frequent GI side effects, expensive, little experience

^* Severe hypoglycemia is relatively infrequent with sulfonylurea therapy. The longer-acting agents (e.g. chlorpropamide, glyburide [glibenclamide], and sustained-release glipizide) are more likely to cause hypoglycemia than glipizide, glimepiride, and gliclazide. Repaglinide is more effective at lowering A1C than nateglinide. GI, gastrointestinal.