Selecting a Treatment Regimen
Table 10. Diabetes Drug Properties
Agent
Durability
Mechanism
Advantages
Biguanides
Metformin
appears
intermediate
in durability
between SUs
and TZDs.
Improve
insulin
sensitivity;
suppress
nocturnal
hepatic glucose
production.
Generally weight neutral or
modest weight loss.
Endogenous
incretins
(GIP, GLP)
rise following
meals
blunting PPG
excursions
via multiple
mechanisms.
DPP-4
inhibitors
greatly retard
the enzymatic
degradation of
incretins.
Improve the inappropriate
hyperglucagonemia of DM.
Mimic effects
of GLP and
GIP following
meals,
blunting PPG
excursions
via multiple
mechanisms.
Patients have weight loss,
usually modest, sometimes
significant. More potent than
DPP-4 inhibitors. Improve the
inappropriate hyperglucagonemia
of DM. Approved for initial
monotherapy as well as
combination with all oral agents.
Stimulate
secretion of
insulin.
Glimepiride 1 mg dose approved
for use in renal failure.
Glinides can be useful for
postprandial hyperglycemia or
hypoglycemia.
Repaglinide is safe with liver/
renal disease.
DPP-4
Inhibitors
Incretin
Mimetics
(GLP-1
receptor
agonists)
Insulin
Secretagogues
(SU or
shorter-acting
glinides)
16
With SUs,
glucose
lowering is
maximal at
6 months;
glucose levels
return towards
baseline
at about 3
years.
DPP-4 inhibitors do not
cause weight gain; they can be
administered in patients with renal
insufficiency with appropriate
dosing adjustment.
