Metformin is the first line of treatment for T2DM with high efficacy, low risk of Hypoglycemia, It reduces weight but is associated with gastrointestinal side effects.
Sulfonylurea, which has moderate risk of hypoglycemia, increase in weight but the cost is low and high efficacy.
Thiazolidinedione, which has low risk of hypoglycemia and have high efficacy, but increase weight and causes edema, heart failure and bladder cancer.
DPP-4 inhibitors have low risk of hypoglycemia, decrease weight and less side effects, but the cost of the drug is very high.
SGLT2 inhibitors have low risk of hypoglycemia and decreases weight, but cause urinary tract infection, dehydration and the cost is very high.
GLP-1 analogues have low risk of hypoglycemia and decreases weight, but causes gastrointestinal disturbance and the cost is very high.
Since the drugs listed above act in different ways to lower blood glucose levels they may be used in combinations for better control and management. For example, a Metformin and a sulfonylurea may be used together. Many combinations can be used. Though taking more than one drug can be more costly and can increase the risk of side effects, combining oral medications can improve blood glucose control when taking only a single drug does not have the desired effects.
- Standards of Medical Care in Diabetes—2015, Diabetes Care Volume 38, Supplement 1, January 2015