Non-insulin glucose-lowering therapies currently licensed for type 2 diabetes management
| Therapy | Dose and frequency | Efficacy | Effect on weight | Adverse effects | Safety | Cost |
|---|---|---|---|---|---|---|
| Oral administration | ||||||
| Biguanides | ||||||
| Metformin | 0.5–2.5 g daily | HbA1c↓∼1% | Weight neutral or weight loss | Nausea, vomiting, bloating, diarrhoea, flatulence | Not safe in moderate/severe renal impairment Risk of lactic acidosis (rare) Vitamin B12 deficiency | Low |
| Glucophage SR | 0.5–2.0 g daily | |||||
| Sulfonylureas, eg, | ||||||
| Gliclazide | 40–160 mg daily | HbA1c↓∼1% | Weight gain | Hypoglycaemia, weight gain | ? Long-term cardiovascular effects | Low |
| Glimepiride | 1–6 mg daily | |||||
| TZDs | ||||||
| Pioglitazone | 15–45 mg daily | HbA1c↓∼1% | Weight gain | Weight gain, peripheral oedema | Heart failure, bone fractures, ? Bladder cancer | Low |
| Meglitinides | ||||||
| Repaglinide | 0.5–16 mg daily | HbA1c↓0.5–0.8% | Weight gain | Hypoglycaemia, weight gain | ? Long-term cardiovascular effects | High |
| DPP-IV inhibitors | ||||||
| Sitagliptin | 25–100 mg daily | HbA1c↓0.8–1% | Weight neutral | Nasopharyngitis, upper respiratory tract infections, headache (all very rare) | Can be used in moderate renal impairment ? Long-term cardiovascular effects ? Heart failure | High |
| Linagliptin | 5 mg daily | |||||
| Saxagliptin | 2.5–5 mg daily | |||||
| Vildagliptin | 50–100 mg daily | |||||
| Alogliptin | 6.25–25 mg daily | |||||
| SGLT-2 inhibitors | ||||||
| Dapagliflozin | 5–10 mg daily | HbA1c | Weight loss | Urinary frequency, urinary tract and mycotic genital infections, volume depletion | Not effective with renal impairment ? Long-term cardiovascular effects | High |
| Canagliflozin | 100–300 mg daily | ↓∼1% | ||||
| Empagliflozin | 10–25 mg daily | |||||
| Subcutaneous injection | ||||||
| GLP-1 receptor agonists | ||||||
| Exenatide | 5–10 μg daily | HbA1c↓∼1–1.5% | Weight loss | Nausea, vomiting | Use with caution in moderate and avoid with severe renal impairment Acute pancreatitis, C-cell hyperplasia/medullary thyroid tumours in animals | Very high |
| Exenatide LA | 2 mg weekly | |||||
| Liraglutide | 0.6–1.8 mg daily | |||||
| Lixisenatide | 10–20 μg daily | |||||
| Albiglutide | 30 mg weekly | |||||
| Dulaglutide | 0.75–1.5 mg weekly | |||||
DPP-IV, dipeptidyl-peptidase IV; TZD, Thiazolidinediones.