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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

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