Table 1

Non-insulin glucose-lowering therapies currently licensed for type 2 diabetes management

TherapyDose and frequencyEfficacyEffect on weightAdverse effectsSafetyCost
Oral administration
 Metformin0.5–2.5 g dailyHbA1c↓∼1%Weight neutral or weight lossNausea, vomiting, bloating, diarrhoea, flatulenceNot safe in moderate/severe renal impairment
Risk of lactic acidosis (rare)
Vitamin B12 deficiency
 Glucophage SR0.5–2.0 g daily
Sulfonylureas, eg,
 Gliclazide40–160 mg dailyHbA1c↓∼1%Weight gainHypoglycaemia, weight gain? Long-term cardiovascular effectsLow
 Glimepiride1–6 mg daily
 Pioglitazone15–45 mg dailyHbA1c↓∼1%Weight gainWeight gain, peripheral oedemaHeart failure, bone fractures, ? Bladder cancerLow
 Repaglinide0.5–16 mg dailyHbA1c↓0.5–0.8%Weight gainHypoglycaemia, weight gain? Long-term cardiovascular effectsHigh
DPP-IV inhibitors
 Sitagliptin25–100 mg dailyHbA1c↓0.8–1%Weight neutralNasopharyngitis, upper respiratory tract infections, headache (all very rare)Can be used in moderate renal impairment
? Long-term cardiovascular effects
? Heart failure
 Linagliptin5 mg daily
 Saxagliptin2.5–5 mg daily
 Vildagliptin50–100 mg daily
 Alogliptin6.25–25 mg daily
SGLT-2 inhibitors
 Dapagliflozin5–10 mg dailyHbA1cWeight lossUrinary frequency, urinary tract and mycotic genital infections, volume depletionNot effective with renal impairment
? Long-term cardiovascular effects
 Canagliflozin100–300 mg daily↓∼1%
 Empagliflozin10–25 mg daily
Subcutaneous injection
GLP-1 receptor agonists
 Exenatide5–10 μg dailyHbA1c↓∼1–1.5%Weight lossNausea, vomitingUse with caution in moderate and avoid with severe renal impairment
Acute pancreatitis, C-cell hyperplasia/medullary thyroid tumours in animals
Very high
 Exenatide LA2 mg weekly
 Liraglutide0.6–1.8 mg daily
 Lixisenatide10–20 μg daily
 Albiglutide30 mg weekly
 Dulaglutide0.75–1.5 mg weekly
  • DPP-IV, dipeptidyl-peptidase IV; TZD, Thiazolidinediones.