14th September 2024

Overview of the medications used to treat type 2 diabetes


Drug class	Examples	Efficacy	CV benefit	Hypoglycemia risk	Effect on weight	Notes
Metformin	–	Moderate	Yes	Low	Reduction
Sulphonylurea	Gliclazide	High	No	High	Gain
SGLT2 inhibitor	Dapagliflozin	Moderate	Yes	Low	Loss	Indicated if QRISK >10% (in those 40 years and over), or if they have pre-existing cardiovascular disease
DPP4 inhibitor	Sitagliptin	Low/Moderate	No	Low	Gain
TZD	Pioglitazone	Moderate	Probable (but fluid retention)	Low	Gain	Contraindicated in patients with a history of heart failure or significant cardiovascular disease
GLP-1 agonist	Dulaglutide	High	Yes	Low	Loss	Stop DPP4i (no additional benefit) Consider reducing sulfonylurea Continue metformin, pioglitazone and SGLT2i
Insulin	Rapid acting (aspart), Intermediate acting (Humulin I), Long acting (glargine)	Very high	No	Highest	Gain	Reduce or stop sulfonylurea Continue metformin, pioglitazone, DPP4i or SGLT2

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