Biguanide | | Inhibits hepatic glucose production. | Mild weight loss. | Reduces MI by 39% and coronary deaths by 50%. | Lactic acidosis. |
Sulfonylurea | Glyburide. Glipizide. Glimepiride.
| Increases insulin secretion. | Weight gain. | Very capable of lowering serum glucose. | High risk of hypoglycemia and increased cardiovascular disease risk. |
Meglitinide | | Glucose-dependent increase in insulin secretion. | Weight gain. | Very capable of lowering serum glucose, with less risk of hypoglycemia as sulfonylurea. | Risk of hypoglycemia effected by inhibitors of CYP3A4 or CYP2C8 in the liver. |
Thiazolidinediones | Rosiglitazone. Pioglitazone.
| Insulin sensitizer. | Weight gain. | Minimal risk of hypoglycemia. | Heart failure, pioglitazone associated with bladder cancer, and fractures. |
Alpha-glucosidase inhibitors | Acarbose. Miglitol. Voglibose.
| Decrease metabolism and absorption of intestinal polysaccharides. | Mild weight loss. | Mild decrease in hemoglobin A1c. | Flatulence, abdominal discomfort, and diarrhea, and transaminitis. |
Dipeptidyl peptidase-4 inhibitors | Alogliptin. Linagliptin. Sitagliptin. Saxagliptin. Vildagliptin.
| Inhibit degradation of glucagon-like peptide. | Neutral. | Decrease postprandial triglycerides. | Pancreatitis and upper respiratory tract infection. |
Sodium-glucose cotransporter-2 inhibitors | Canagliflozin. Dapagliflozin. Empagliflozin. Ertugliflozin.
| Glucosuria due to blocking (90%) of glucose reabsorption in renal PCT; insulin-independent mechanism of action. | Weight loss. | Reduce sodium and uric acid absorption, reduce systolic blood pressure, and reduce renal failure progression. | Euglycemic ketoacidosis, fractures, and genital mycosis. |
Glucagon-like peptide 1 (GLP-1) receptor agonists | Semaglutide. Liraglutide. Exenatide. Dulaglutide.
| Activate GLP-1 receptor, increased insulin and decreased glucagon secretion, delayed gastric emptying, and increased satiety. | Weight loss. | Cardiovascular risk reduction. | Nausea, vomiting, pancreatitis, and C cell tumor of the thyroid (contraindicated in MEN type 2). |