Type 2 Diabetes Antidiabetic Drugs

Non-Insulin Antidiabetic Drugs

• Metformin hydrochloride lowers both basal and postprandial blood-glucose concentrations without causing weight gain or hypoglycaemia.
• Sulfonylureas (e.g., gliclazide, glimepiride) may cause hypoglycaemia, especially with long-acting agents like glimepiride, and are associated with modest weight gain.
• Acarbose has a poorer anti-hyperglycaemic effect compared to many other antidiabetic drugs.

Meglitinides and Thiazolidinediones

• Meglitinides (e.g., repaglinide) have a rapid onset of action and short duration of activity, allowing flexible dosing around mealtimes.
• Thiazolidinediones (e.g., pioglitazone) are associated with weight gain and long-term risks, requiring regular review of ongoing benefit.

DPP-4 Inhibitors and SGLT2 Inhibitors

• DPP-4 inhibitors (e.g., alogliptin, linagliptin) do not appear to cause weight gain and have a lower incidence of hypoglycaemia compared to sulfonylureas.
• SGLT2 inhibitors (e.g., canagliflozin, dapagliflozin) lower blood-glucose, promote weight loss, and improve cardiovascular outcomes in certain patients, but are associated with a risk of diabetic ketoacidosis.

GLP-1 Receptor Agonists and GIP/GLP-1 Receptor Agonists

• GLP-1 receptor agonists (e.g., dulaglutide, liraglutide) promote weight loss and may improve cardiovascular outcomes in some patients, and are reserved for combination therapy when other options have failed.
• Dual GIP/GLP-1 receptor agonists (e.g., tirzepatide) promote weight loss and can be used as an alternative to GLP-1 receptor agonists in combination therapy.