Diabetes Medications

Metformin (Biguanide)

Brand Names: Glucophage
Mechanism: Decreases hepatic glucose production and improves insulin sensitivity in muscle tissue.
Preferred Use: First-line treatment for Type 2 diabetes, especially in overweight or obese patients, as it can aid weight loss.
Avoid in: Advanced kidney disease (eGFR <30 mL/min), liver disease, alcohol abuse, and conditions with risk of lactic acidosis (e.g., heart failure, severe infection).

Sulfonylureas (e.g., Glipizide, Glyburide, Glimepiride)

Brand Names: Glipizide (Glucotrol), Glyburide (Diabeta, Micronase), Glimepiride (Amaryl)
Mechanism: Stimulate pancreatic beta cells to release insulin.
Preferred Use: Patients with early Type 2 diabetes who can benefit from an oral insulin secretagogue.
Avoid in: Elderly patients (risk of hypoglycemia), kidney disease, liver disease, and those with a high risk of hypoglycemia.

DPP-4 Inhibitors (e.g., Sitagliptin, Saxagliptin, Linagliptin)

Brand Names: Sitagliptin (Januvia), Saxagliptin (Onglyza), Linagliptin (Tradjenta)
Mechanism: Inhibit DPP-4 enzyme, increasing incretin levels which help stimulate insulin release and decrease glucagon levels.
Preferred Use: Add-on therapy in Type 2 diabetes when metformin alone is insufficient; generally well-tolerated with a low hypoglycemia risk.
Avoid in: Severe renal impairment (except Linagliptin), heart failure (especially with Saxagliptin), and pancreatitis history.

GLP-1 Receptor Agonists (e.g., Liraglutide, Dulaglutide, Semaglutide)

Brand Names: Liraglutide (Victoza), Dulaglutide (Trulicity), Semaglutide (Ozempic, Rybelsus)
Mechanism: Mimic incretin hormones, increasing insulin release, decreasing glucagon, and slowing gastric emptying.
Preferred Use: Type 2 diabetes with high cardiovascular risk or obesity; promotes weight loss and reduces cardiovascular events.
Avoid in: Personal or family history of medullary thyroid carcinoma or multiple endocrine neoplasia syndrome type 2 (MEN 2), pancreatitis.

SGLT-2 Inhibitors (e.g., Canagliflozin, Empagliflozin, Dapagliflozin)

Brand Names: Canagliflozin (Invokana), Empagliflozin (Jardiance), Dapagliflozin (Farxiga)
Mechanism: Increase urinary glucose excretion by inhibiting SGLT-2 in the proximal renal tubules.
Preferred Use: Type 2 diabetes with cardiovascular disease, heart failure, or chronic kidney disease; also aids in weight loss.
Avoid in: Severe renal impairment, frequent urinary tract infections or fungal infections, hypotension, and dehydration risk.

Thiazolidinediones (e.g., Pioglitazone, Rosiglitazone)

Brand Names: Pioglitazone (Actos), Rosiglitazone (Avandia)
Mechanism: Improve insulin sensitivity by acting on PPAR-gamma receptors in adipose tissue, muscle, and liver.
Preferred Use: Type 2 diabetes patients needing additional glucose-lowering effects, particularly if they have no heart failure risk.
Avoid in: Heart failure (NYHA Class III or IV), liver disease, bladder cancer (especially Pioglitazone), and osteoporosis due to fracture risk.

Insulin (Various Types: Rapid, Short, Intermediate, Long-acting)

Brand Names:
- Rapid-acting: Lispro (Humalog), Aspart (Novolog)
- Short-acting: Regular insulin (Humulin R, Novolin R)
- Intermediate: NPH (Humulin N, Novolin N)
- Long-acting: Glargine (Lantus, Basaglar), Detemir (Levemir)
Mechanism: Lowers blood glucose by facilitating cellular glucose uptake.
Preferred Use: Type 1 diabetes (all patients) and Type 2 with insufficient control or pregnancy.
Avoid in: Hypoglycemia; caution with patients needing consistent meal intake.

Meglitinides (e.g., Repaglinide, Nateglinide)

Alpha-Glucosidase Inhibitors (e.g., Acarbose, Miglitol)