Advantages
Disadvantages
Cost
• Extensive experience
• No weight gain
• No hypoglycemia
• Likely ↓ CVD events
(UKPDS)
• Gastrointestinal side effects (diarrhea,
abdominal cramping)
• Lactic acidosis risk (rare)
• Vitamin B12 deficiency
• Multiple contraindications: CKD,
acidosis, hypoxia, dehydration, etc.
• Hypoglycemia
• Weight gain
• ? Blunts myocardial ischemic
preconditioning
• Low durability
• Hypoglycemia
• Weight gain
• ? Blunts myocardial ischemic
preconditioning
• Frequent dosing schedule
• Weight gain
• Edema/heart failure
• Bone fractures
• ↑ LDL-C (rosiglitazone)
• ? ↑ MI (meta-analyses, rosiglitazone)
• ? ↑ Bladder cancer (pioglitazone)
Low
• Generally modest HbA1c efficacy
• Gastrointestinal side effects (flatulence,
diarrhea)
• Frequent dosing schedule
Moderate
• Generally modest HbA1c efficacy
• Urticaria/angioedema
• ? Pancreatitis
High
• Generally modest HbA1c efficacy
• Constipation
• ↑ Triglycerides
• May ↓ absorption of other medications
High
• Extensive experience
• ↓ Microvascular risk
(UKPDS)
• ↓ Postprandial glucose
excursions
• Dosing flexibility
• No hypoglycemia
• Durability
• ↑ HDL-C
• ↓ Triglycerides
(pioglitazone)
• ? ↓ CVD events
(ProACTIVE,
pioglitazone)
• No hypoglycemia
• ↓ Postprandial glucose
excursions
• ? ↓ CVD events
(STOP-NIDDM)
• Nonsystemic
• No hypoglycemia
• Well tolerated
• No hypoglycemia
• ↓ LDL-C
Low
High
Highd
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