Advantages
• Extensive experience • No weight gain • No hypoglycemia • Likely ↓ CVD events (UKPDS)
• 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
• Generally modest HbA1c efficacy • Urticaria/angioedema • ? Pancreatitis
High
Disadvantages
• Gastrointestinal side effects (diarrhea, abdominal cramping)
• Lactic acidosis risk (rare) • Vitamin B12
• Multiple contraindications: CKD, acidosis, hypoxia, dehydration, etc.
deficiency
• 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)
• Generally modest HbA1c efficacy • Gastrointestinal side effects (flatulence, diarrhea)
• Frequent dosing schedule Highd Low
Cost Low
High
Moderate
• No hypoglycemia • ↓ LDL-C
• Generally modest HbA1c efficacy • Constipation • ↑ Triglycerides • May ↓ absorption of other medications
High
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