Table 1—

Summary of antidiabetic interventions as monotherapy

InterventionsExpected decrease in A1C (%)AdvantagesDisadvantages
Step 1: initial
    Lifestyle to decrease weight     and increase activity1–2Low cost, many benefitsFails for most in 1st year
    Metformin1.5Weight neutral, inexpensiveGI side effects, rare lactic acidosis
Step 2: additional therapy
    Insulin1.5–2.5No dose limit, inexpensive, improved lipid profileInjections, monitoring, hypoglycemia, weight gain
    Sulfonylureas1.5InexpensiveWeight gain, hypoglycemia*
    TZDs0.5–1.4Improved lipid profileFluid retention, weight gain, expensive
Other drugs
    α-Glucosidase inhibitors0.5–0.8Weight neutralFrequent GI side effects, three times/day dosing, expensive
    Exenatide0.5–1.0Weight lossInjections, frequent GI side effects, expensive, little experience
    Glinides1–1.5†Short durationThree times/day dosing, expensive
    Pramlintide0.5–1.0Weight lossInjections, 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.