Drugs for Type 2 Diabetes

Full update December 2020

The table below summarizes the agents available in the U.S. for the treatment of type 2 diabetes, including expected A1C reduction when added to metformin, cost, adverse effects, and other pertinent information (e.g., frequency of dosing, cardiovascular benefits). For additional details on cardiovascular benefits associated with drugs for type 2 diabetes, see our chart, Diabetes Medications and Cardiovascular Impact.

Expected A1C Drop When Added to Metformin23

MOA

Maximum Daily Dose24
(Cost/30 Days)a

Notable Adverse Effects

Comments

Alpha-glucosidase inhibitors: acarbose (Precose, generics) and miglitol (Glyset, generics)

0.7% to 0.8% (acarbose)

0.7% (miglitol, when added to sulfonylurea, not metformin)36

MOA: slows intestinal carbohydrate digestion/absorption.21,24

 

Acarbose
300 mg, divided TID
(~$55)

Miglitol
300 mg, divided TID
(~$200)

GI (e.g., abdominal pain, flatulence, diarrhea).23,24

Low risk of hypoglycemia when used as monotherapy.23

Weight neutral.23

Taken with meals.24

Reduces postprandial glucose.21

Requires frequent dosing
(e.g., TID).21

Beneficial in the treatment of prediabetes (acarbose).9

 

Amylin analog: pramlintide (Symlin)

~0.36% when added to insulin with or without metformin and/or a sulfonylurea33

MOA: slows gastric emptying, increases the feeling of fullness, and reduces postprandial glucagon secretion.21,24

 

Pramlintide
120 mcg/dose (usually 360 mcg/day; divided, prior to major meals)
(~$2,250)

GI (e.g., nausea, vomiting).21

Hypoglycemia rare, unless insulin dose not reduced.21

Weight loss.21

Increased feeling of fullness after meal.21

Injectable.21

Taken immediately before meals.24

Reduces postprandial glucose.21

Requires frequent dosing.21

Biguanide: metformin (Glucophage, Glucophage XR, generics). Available in combination with alogliptin, canagliflozin, dapagliflozin, empagliflozin, ertugliflozin, glipizide, glyburide, linagliptin, pioglitazone, repaglinide, saxagliptin, and sitagliptin. See specific agents.

1% as monotherapy

MOA: inhibits production of glucose, intestinal absorption of glucose, and increases insulin sensitivity in muscle and fat.21,24

Metformin
2,000 to 2,550 mg, divided BID to TID
(~$10)

Metformin XR
2,000 mg to 2,500 mg, divided BID
(~$20)

B12 deficiency.23,49

GI (e.g., diarrhea, nausea, cramping).21,23

Lactic acidosis (rare) in patients with cardiovascular, renal, or hepatic dysfunction.21,24

Low risk of hypoglycemia when used as monotherapy.23

Weight neutral.21,23

Ameliorates insulin-associated weight gain.23

First-line after diet and exercise for most patients.21

Beneficial in the treatment of prediabetes.10

May reduce cardiovascular mortality.42

Safe in patients with stable heart failure and moderate renal impairment:3,16,25,26

Can be initiated in patients with an
eGFR >45 mL/min/1.73m2.24

Discontinue if eGFR falls below
30 mL/min/1.73m2.24

 

Dipeptidyl peptidase-4 (DPP-4) inhibitor (“gliptins”) or incretin enhancer:

  • alogliptin (Nesina, generics, with metformin [Kazano], with pioglitazone [Oseni])
  • linagliptin (Tradjenta, with metformin [Jentadueto, Jentadueto XR], with empagliflozin [Glyxambi], with metformin and empagliflozin [Trijardy XR])
  • saxagliptin (Onglyza, with metformin [Kombiglyze XR], with dapagliflozin [Qtern])
  • sitagliptin (Januvia, with metformin [Janumet, Janumet XR], with ertugliflozin [Steglujan])

 

0.5% to 0.7%

MOA: increases insulin secretion in response to elevated blood glucose, decreases glucagon secretion, increases sense of fullness, and slows gastric emptying.21,24


Alogliptin 25 mg
(~$195)

Linagliptin 5 mg
(~$460)

Saxagliptin 5 mg
(~$425)

Sitagliptin 100 mg
(~$475)

May be associated with pancreatitis.6,21

New or worsening heart failure (saxagliptin and alogliptin).7,8,13,17,21,43

May cause severe joint pain.12

Low risk of hypoglycemia when used as monotherapy.21,23

Dosage modification with renal impairment needed (sitagliptin, saxagliptin, alogliptin).24

CYP3A4 interactions (saxagliptin, linagliptin).24

Reduces postprandial glucose.44

Weight neutral.23

Generally, well tolerated.21

Glucagon-like, peptide-1 (GLP-1) agonist or incretin mimetic:

  • dulaglutide (Trulicity)
  • exenatide (Byetta) and exenatide extended-release (Bydureon, Bydureon BCise)
  • liraglutide (Victoza, with insulin degludec [Xultophy])
  • lixisenatide (Adlyxin, with insulin glargine [Soliqua])
  • semaglutide (Ozempic, Rybelsus)

 

1%
(See GLP-1 agonist chart for individual agents)

MOA: increases insulin secretion in response to elevated blood glucose, decreases glucagon secretion, leading to reduced hepatic glucose production and slowed gastric emptying.21,24

See our chart, Comparison of GLP-1 Agonists, for dosing and cost info.

GI (diarrhea, nausea).21

May be associated with pancreatitis (rare).6,21

May be associated with gallbladder disease (liraglutide, exenatide).18,19

Low risk of hypoglycemia when used as monotherapy.21

May lead to retinopathy complications (semaglutide).41

Weight loss.21

Injectable.21

Linked to thyroid cell cancer in rats.21

Avoid if eGFR <45 mL/min/1.73m2 (extended-release exenatide),
<30 mL/min/1.73m2 (immediate-release exenatide), or
<15 mL/min/1.73m2 (lixisenatide).24

Reduces postprandial glucose.21

CV benefit (albiglutide, dulaglutide, liraglutide, semaglutide).19,22,39,40,62

Renal benefit (liraglutide, semaglutide).19,40,53

In patients who need more than one or two diabetes meds, combination therapy with basal insulin and a GLP-1 agonist is an emerging strategy.1

 

Insulin: various

0.9% to 1.2% or more

MOA: promotes storage of glucose in muscle and fat tissues, and inhibits production of glucose.21,24


No maximum dose.23
See our chart, Comparison of Insulins, for cost info.

Hypoglycemia (educate patient to prevent, recognize, and manage).21

Highest risk of weight gain.21,23

Consider initial therapy with insulin plus metformin if blood glucose is ≥300 mg/dL and/or A1C is ≥10%.21

Meglitinide: nateglinide (Starlix, generics) and repaglinide (Prandin [discontinued], generics, with metformin [PrandiMet (discontinued), generics])

0.7% to 1.1%

MOA: stimulates pancreatic insulin secretion.21,24

Nateglinide
360 mg, divided TID
(~$65)

Repaglinide
16 mg, divided TID
(~$35)

Hypoglycemia (educate patient to prevent, recognize, and manage).21

Weight gain.21

Requires frequent dosing.21

Reduces postprandial glucose.21

Provides flexible dosing (e.g., can hold dose if skipping meal).21,24

Consider over sulfonylureas (less hypoglycemia, better postprandial control).2

 

Sodium-glucose co-transporter 2 (SGLT2) inhibitors:

  • canagliflozin (Invokana, with metformin [Invokamet, Invokamet XR])
  • dapagliflozin (Farxiga, with metformin [Xigduo XR], with saxagliptin [Qtern])
  • empagliflozin (Jardiance, with linagliptin [Glyxambi], with metformin [Synjardy, Synjardy XR], with linagliptin and metformin [Trijardy XR])
  • ertugliflozin (Steglatro, with metformin [Segluromet], with sitagliptin [Steglujan])

0.4% to 0.7%

MOA: blocks glucose reabsorption in the kidney, and increases urinary excretion of glucose.21,24

Canagliflozin 300 mg
(~$520)

Dapagliflozin 10 mg
(~$520)

Empagliflozin 25 mg
(~$520)

Ertugliflozin 15 mg
(~$295)

Genital fungal (yeast) infections (male/female).2

UTI (may be severe), ketoacidosis (rare).14

Dizziness, hypotension, hypoglycemia (rare), increased LDL/urination, volume depletion.21,54

Hyperkalemia (canagliflozin), especially with high baseline potassium and renal impairment.35

Fractures (rare, in susceptible patients).4

Decrease in BMD (canagliflozin).11

Acute kidney injury, may require dialysis.15,24

May be associated with acute pancreatitis (rare).46,48

Fournier’s gangrene (rare; in men and women). Onset: days to years into therapy.47

May be associated with rare amputations (canagliflozin).27

Weight loss.21

Do not use if eGFR <45 mL/min/1.73m2 (not recommended: dapagliflozin and empagliflozin [for diabetes; contraindicated <30 mL/min/1.73m2]), or
<30 mL/min/1.73m2 (dapagliflozin [for heart failure, due to insufficient data], canagliflozin [may continue at 100 mg/day in patients with albuminuria >300 mg/day when NOT using for glycemic control], ertugliflozin).24

CV benefit (canagliflozin, dapagliflozin, empagliflozin).18,20,37,38,50,55,56,59-61

Renal benefit (canagliflozin, dapagliflozin, empagliflozin).50,55,57,58

Consider using with caution in patients with a history of amputation or an active peripheral arterial ulcer, especially canagliflozin.27,52

 

Sulfonylurea–first generation:

  • chlorpropamide (Diabinese [discontinued], generics)
  • tolazamide (Tolinase [discontinued], generics)
  • tolbutamide (Orinase [discontinued], generics)

1% to 1.5% as monotherapy45

MOA: stimulates pancreatic insulin secretion.21,24

Chlorpropamide
750 mg24
(~$100)

Tolazamide
1,000 mg (daily doses
>500 mg divide BID)24
(~$170)

Tolbutamide
3,000 mg (given once daily or divided up to TID)24
(~$170)

 

Hypoglycemia (educate patient to prevent, recognize, and manage).21

More common than with second-generation sulfonylureas.5

Weight gain.5

Increased CV mortality (tolbutamide).29

Discontinue when more complex insulin regimens (e.g., basal plus prandial insulins) are started.1

Second-generation sulfonylureas preferred over first-generation sulfonylureas, due to lower risk of hypoglycemia.5

Relatively short-lived efficacy.1

Avoid chlorpropamide in patients with renal dysfunction or the elderly.24

Sulfonylurea-second generation

  • glyburide (DiaBeta [discontinued], Glynase, Micronase [discontinued], generics, with metformin [Glucovance, generics])
  • glipizide (Glucotrol, Glucotrol XL, generics, with metformin [Metaglip, generics])
  • glimepiride (Amaryl, generics, with pioglitazone [Duetact, generics], with rosiglitazone [Avandaryl])

0.7% to 1.3%

MOA: stimulates pancreatic insulin secretion.21,24

Glimepiride 8 mg
(~$15)

Glipizide IR 40 mg (daily doses >30 mg should be divided BID)
(less than $10)

Glipizide XL 20 mg
(~$25)

Glyburide (standard)
20 mg (daily doses
>10 mg can be divided BID)
(~$25)

Glyburide (micronized) 12 mg (once daily or in divided doses)
(~$5)


Hypoglycemia, especially with renal dysfunction (educate patient to prevent, recognize, and manage).21

Less with glimepiride versus glyburide.5 Avoid both in the elderly.51

Weight gain.

Less with glipizide and glimepiride versus glyburide.5

 

Discontinue when more complex insulin regimens (e.g., basal plus prandial insulins) are started.1

Relatively short-lived efficacy.1

For the elderly and those with hepatic or renal dysfunction, start with low doses and titrate up.21

 

Thiazolidinedione (TZD)

  • pioglitazone (Actos, generics, with metformin [ACTOplus Met or ACTOplus Met XR], with glimepiride [Duetact, generics], with alogliptin [Oseni, generics])
  • rosiglitazone (Avandia, with metformin [Avandamet])

0.8% to 0.9%

MOA: increases insulin sensitivity in muscle and fat.21,24

Pioglitazone 45 mg
(less than $10)

Rosiglitazone 8 mg
(~$340)

Low risk of hypoglycemia when used as monotherapy.21

Edema.21

Weight gain.21

Heart failure.21

Increased fracture risk.21

Increased LDL (rosiglitazone).21

Possible increased risk of bladder cancer (pioglitazone). Assess risk factors and counsel patients to report hematuria.31,34

 

Glycemic control better sustained over diabetes course than metformin or sulfonylureas.21

Pioglitazone may improve lipid profile (e.g., lowers triglycerides).21

Avoid in patients with symptomatic heart failure.21

CV benefit (pioglitazone).30

Others – bile acid sequestrant: colesevelam (Welchol, generics)

0.5%32

MOA: may reduce hepatic glucose production, increase incretin levels, and decrease glucose absorption.21


Colesevelam
3.75 gm, given once daily or divided BID (~$450 [powder for suspension]; ~$160 [tablets])

GI (e.g., constipation, nausea, bloating).21

May increase triglycerides.21

Rare hypoglycemia.21

Lowers LDL cholesterol.21

May decrease absorption of other meds.21

 

Others – dopamine agonist: bromocriptine (Cycloset)

0.5% when added to metformin and a sulfonylurea28

MOA: may centrally regulate metabolism, increases insulin sensitivity.21


Bromocriptine 4.8 mg
(~$800)

Fatigue.21

Dizziness/syncope.21

Nausea.21

Rare hypoglycemia.21

 

Weight neutral.28

CYP3A4 interactions.24

 

a.   Pricing (for generic when available) based on wholesale acquisition cost (WAC). Medication pricing by Elsevier, accessed October 2020.

Abbreviations: BID = two times daily; CVD = cardiovascular disease; eGFR = estimated glomerular filtration rate; GI = gastrointestinal; MOA = mechanism of action; TID = three times daily; UTI = urinary tract infection.

Prepared by the Editors of Therapeutic Research Center (361201).

References

  1. Inzucchi SE, Bergenstal RM, Buse JB, et al. Management of hyperglycemia in type 2 diabetes, 2015: a patient-centered approach: update to a position statement of the American Diabetes Association and the European Association for the Study of Diabetes. Diabetes Care 2015;38:140-9.
  2. Garber AJ, Abrahamson MJ, Barzilay JI, et al. Consensus statement by the American Association of Clinical Endocrinologists and American College of Endocrinology on the comprehensive type 2 diabetes management algorithm – 2017 executive summary. Endo Pract 2017;23:207-38.
  3. Lim VC, Sum CF, Chan ES, et al. Lactate levels in Asian patients with type 2 diabetes mellitus on metformin and its association with dose of metformin and renal function. Int J Clin Pract 2007;61:1829-33.
  4. Hackethal V. SGLT2 inhibitors and fracture risk: a review of what we know. Endocrinology Network, March 29, 2015. https://www.endocrinologynetwork.com/view/sglt2-inhibitors-and-fracture-risk-review-what-we-know. (Accessed October 29, 2020).
  5. Nathan DM, Buse JB, Davidson MB, et al. Medical management of hyperglycemia in type 2 diabetes: a consensus algorithm for the initiation and adjustment of therapy: a consensus statement of the American Diabetes Association and the European Association for the Study of Diabetes. Diabetes Care 2009;32:193-203.
  6. Egan AG, Blind E, Dunder K, et al. Pancreatic safety of incretin-based drugs-FDA and EMA assessment. N Engl J Med 2014;370:794-7.
  7. Scirica BM, Bhatt DL, Braunwald E, et al. Saxagliptin and cardiovascular outcomes in patients with type 2 diabetes mellitus. N Engl J Med 2013;369:1317-26.
  8. Zannad F, Cannon CP, Cushman WC, et al. Heart failure and mortality outcomes in patients with type 2 diabetes taking alogliptin versus placebo in EXAMINE: a multicentre, randomised, double-blind trial. Lancet 2015;385:2067-76.
  9. Chiasson JL, Josse RG, Gomis R, et al. Acarbose for prevention of type 2 diabetes mellitus: the STOP-NIDDM randomised trial. Lancet 2002;359:2072-7.
  10. Diabetes Prevention Program Research Group. Long-term safety, tolerability, and weight loss associated with metformin in the Diabetes Prevention Program Outcomes Study. Diabetes Care 2012;35:731-7.
  11. FDA. FDA drug safety communication: FDA revises label of diabetes drug canagliflozin (Invokana, Invokamet) to include updates on bone fracture risk and new information on decreased bone mineral density. January 15, 2016. https://www.fda.gov/drugs/drug-safety-and-availability/fda-drug-safety-communication-fda-revises-label-diabetes-drug-canagliflozin-invokana-invokamet. (Accessed October 29, 2020).
  12. FDA. FDA drug safety communication: FDA warns that DPP-4 inhibitors for type 2 diabetes may cause severe joint pain. June 23, 2016. https://www.fda.gov/drugs/drug-safety-and-availability/fda-drug-safety-communication-fda-warns-dpp-4-inhibitors-type-2-diabetes-may-cause-severe-joint-pain. (Accessed October 29, 2020).
  13. Udell JA, Bhatt DL, Braunwald E, et al. Saxagliptin and cardiovascular outcomes in patients with type 2 diabetes and moderate or severe renal impairment: observations from the SAVOR-TIMI 53 trial. Diabetes Care 2015;38:696-705.
  14. FDA. FDA drug safety communication: FDA revises labels of SGLT2 inhibitors for diabetes to include warnings about too much acid in the blood and serious urinary tract infections. Last updated March 19, 2020. https://www.fda.gov/drugs/drug-safety-and-availability/fda-revises-labels-sglt2-inhibitors-diabetes-include-warnings-about-too-much-acid-blood-and-serious. (Accessed October 29, 2020).
  15. FDA. FDA drug safety communication: FDA strengthens kidney warnings for diabetes medicines canagliflozin (Invokana, Invokamet) and dapagliflozin (Farxiga, Xigduo XR). Last updated June 17, 2016. https://www.fda.gov/drugs/drug-safety-and-availability/fda-drug-safety-communication-fda-strengthens-kidney-warnings-diabetes-medicines-canagliflozin. (Accessed October 29, 2020).
  16. Salpeter SR, Greyber E, Pasternak GA, Salpeter EE. Risk of fatal and nonfatal lactic acidosis with metformin use in type 2 diabetes mellitus. Cochrane Database Syst Rev 2010;(4):CD002967.
  17. FDA. FDA drug safety communication: FDA adds warnings about heart failure risk to labels of type 2 diabetes medicines containing saxagliptin and alogliptin. Last updated March 7, 2018. https://www.fda.gov/drugs/drug-safety-and-availability/fda-drug-safety-communication-fda-adds-warnings-about-heart-failure-risk-labels-type-2-diabetes. (Accessed October 29, 2020).
  18. Faillie JL, Yu OH, Yin H, et al. Association of bile duct and gallbladder diseases with the use of incretin-based drugs in patients with type 2 diabetes mellitus. JAMA Intern Med 2016;176:1474-81.
  19. Marso SP, Daniels GH, Brown-Frandsen K, et al. Liraglutide and cardiovascular outcomes in type 2 diabetes. N Engl J Med 2016;375:311-22.
  20. Zinman B, Wanner C, Lachin JM, et al. Empagliflozin, cardiovascular outcomes, and mortality in type 2 diabetes. N Engl J Med 2015;373:2117-28.
  21. American Diabetes Association. Standards of medical care in diabetes – 2017. https://professional.diabetes.org/sites/professional.diabetes.org/files/media/dc_40_s1_final.pdf. (Accessed October 29, 2020).
  22. Hernandez AF, Green JB, Janmohamed S, et al. Albiglutide and cardiovascular outcomes in patients with type 2 diabetes and cardiovascular disease (Harmony Outcomes): a double-blind, randomised placebo-controlled trial. Lancet 2018;392:1519-29.
  23. Diabetes Canada Clinical Guideline Expert Committee, Lipscombe L, Booth G, et al. Pharmacologic glycemic management of type 2 diabetes in adults. Can J Diabetes 2018;42(Supp 1):S88-103.
  24. Clinical Pharmacology powered by ClinicalKey. Tampa (FL): Elsevier. 2020. http://www.clinicalkey.com. (Accessed October 29, 2020).
  25. Frid A, Sterner GN, Löndahl M, et al. Novel assay of metformin levels in patients with type 2 diabetes and varying levels of renal function: clinical recommendations. Diabetes Care 2010;33:1291-3.
  26. Liu F, Lu JX, Tang JL, et al. Relationship of plasma creatinine and lactic acid in type 2 diabetic patients without renal dysfunction. Chin Med J (Engl) 2009;122:2547-53.
  27. FDA. FDA removes boxed warning about risk of leg and foot amputations for the diabetes medicine canagliflozin (Invokana, Invokamet, Invokamet XR). September 2, 2020. https://www.fda.gov/drugs/drug-safety-and-availability/fda-removes-boxed-warning-about-risk-leg-and-foot-amputations-diabetes-medicine-canagliflozin. (Accessed November 6, 2020).
  28. Product information for Cycloset. Vero Science. Tiverton, RI 02878. February 2020.
  29. Meinert CL, Knatterud GL, Prout TE, Klimt CR. A study of the effects of hypoglycemic agents on vascular complications in patients with adult-onset diabetes. II. Mortality results. Diabetes 1970;19(Suppl):789-830.
  30. Dormandy JA, Charbonnel B, Eckland DJ, et al. Secondary prevention of macrovascular events in patients with type 2 diabetes in the PROactive Study (PROspective pioglitAzone Clinical Trial In macroVascular Events): a randomised controlled trial. Lancet 2005;366:1279-89.
  31. FDA. FDA drug safety communication. Updated FDA review concludes that use of type 2 diabetes medicine pioglitazone may be linked to an increased risk of bladder cancer. December 12, 2016. https://www.fda.gov/media/101952/download. (Accessed October 29, 2020).
  32. Product information for Welchol. Daiichi Sankyo. Basking Ridge, NJ 07920. July 2020.
  33. Product information for Symlin. AstraZeneca Pharmaceuticals. Wilmington, DE 19850. December 2019.
  34. Health Canada. Actos (pioglitazone hydrochloride)—potential association with bladder cancer—for health professionals. March 1, 2013. http://www.healthycanadians.gc.ca/recall-alert-rappel-avis/hc-sc/2012/15854a-eng.php. (Accessed October 29, 2020).
  35. Product information for Invokana. Janssen Pharmaceuticals. Titusville, NJ 08560. August 2020.
  36. Product information for Glyset. Pharmacia & Upjohn. Division of Pfizer. New York, NY 10017. August 2016.
  37. Neal B, Perkovic V, Matthews DR, et al. Canagliflozin and cardiovascular and renal events in type 2 diabetes. N Engl J Med 2017;377:2099.
  38. McMurray JJV, Solomon SD, Inzucchi SE, et al. Dapagliflozin in patients with heart failure and reduced ejection fraction. N Engl J Med 2019;381;1195-2008.
  39. Husain M, Birkenfeld AL, Donsmark M, et al. Oral semaglutide and cardiovascular outcomes in patients with type 2 diabetes. N Engl J Med 2019;381:841-51.
  40. Marso SP, Bain SC, Consoli A, et al. Semaglutide and cardiovascular outcomes in patients with type 2 diabetes. N Engl J Med 2016;375:1834-44.
  41. Product information for Ozempic. AstNovo Nordisk. Plainsboro, NJ 08536. September 2020.
  42. Effect of intensive blood-glucose control with metformin on complications in overweight patients with type 2 diabetes (UKPDS 34). UK Prospective Diabetes Study (UKPDS) Group. Lancet 1998;352:854-65.
  43. White WB, Cannon CP, Heller SR, et al. Alogliptin after acute coronary syndrome in patients with type 2 diabetes. N Engl J Med 2013;369:1327-35.
  44. Canadian Diabetes Association Clinical Practice Guidelines Expert Committee, Harper W, Clement M, et al. Pharmacologic management of type 2 diabetes. Can J Diabetes 2013;37(Suppl 1):S61-8.
  45. Inzucchi SE, Bergenstal RM, Buse JB, et al. Management of hyperglycemia in type 2 diabetes: a patient-centered approach: position statement of the American Diabetes Association (ADA) and the European Association for the Study of Diabetes (EASD). Diabetes Care 2012;35:1364-79.
  46. Health Canada. Summary safety review – SGLT2 inhibitors (canagliflozin, dapagliflozin and empagliflozin) – Health Canada. Last updated September 17, 2020. https://hpr-rps.hres.ca/reg-content/summary-safety-review-detail.php?lang=en&linkID=SSR00204. (Accessed October 29, 2020).
  47. FDA. FDA warns about rare occurrences of a serious infection of the genital area with SGLT2 inhibitors for diabetes. September 7, 2018. https://www.fda.gov/drugs/drug-safety-and-availability/fda-warns-about-rare-occurrences-serious-infection-genital-area-sglt2-inhibitors-diabetes. (Accessed October 29, 2020).
  48. American College of Cardiology Foundation. Cohort study of serious adverse events with sodium-glucose cotransporter 2 inhibitors. 2018. https://www.acc.org/~/media/Clinical/PDF-Files/Approved-PDFs/2018/08/21/ESC-2018-Slides/Aug25-Sat/5amET_Serious-Adverse-Events-SGLT2-Inhibitors.pdf. (Accessed October 29, 2020).
  49. American Diabetes Association. 9. Pharmacologic approaches to glycemic treatment: standards of medical care in diabetes-2019. Diabetes Care 2019;42(Suppl 1):S90-S102.
  50. Perkovic V, Jardine MJ, Neal B, et al. Canagliflozin and renal outcomes in type 2 diabetes and nephropathy. N Engl J Med 2019;380:2295-306.
  51. 2019 American Geriatrics Society Beers Criteria Update Expert Panel. American Geriatrics Society 2019 updated AGS Beers Criteria for potentially inappropriate medication use in older adults. J Am Geriatric Soc 2019;67:674-94.
  52. O’Meara E, McDonald M, Chan M, et al. CCS/CHFS heart failure guidelines: clinical trial update on functional mitral regurgitation, SGLT2 inhibitors, ARNI in HFpEF, and tafamidis in amyloidosis. Can J Cardiol 2020;36:159-69.
  53. Mann JFE, Orsted DD, Brown-Frandsen K, et al. Liraglutide and renal outcomes in type 2 diabetes. N Engl J Med 2017;377:839-48.
  54. Packer M, Anker SD, Butler J, et al. Cardiovascular and renal outcomes with empagliflozin in heart failure. N Engl J Med 2020;383:1413-24.
  55. Heerspink HJL, Stefansson BV, Correa-Rotter R, et al. Dapagliflozin in patients with chronic kidney disease. N Engl J Med 2020;381:1436-46.
  56. Neal B, Perkovic V, Mahaffey KW, et al. Canagliflozin and cardiovascular and renal events in type 2 diabetes. N Engl J Med 2017;377:644-57.
  57. Wanner C, Inzucchi SE, Lachin JM, et al. Empagliflozin and progression of kidney disease in type 2 diabetes. N Engl J Med 2016;375:323-34.
  58. Perkovic V, Heerspink HL, Chalmers J, et al. Intensive glucose control improves kidney outcomes in patients with type 2 diabetes. Kidney Int 2013;83:517-23.
  59. Wiviott SD, Raz I, Bonaca MP, et al. Dapagliflozin and cardiovascular outcomes in type 2 diabetes. N Engl J Med 2019;380:347-57.
  60. ClinicalTrials.gov. Empagliflozin outcome trial in patients with chronic heart failure with preserved ejection fraction (EMPEROR-preserved). Updated November 5, 2020. https://clinicaltrials.gov/ct2/show/NCT03057951. (Accessed November 16, 2020).
  61. Packer M, Anker SD, Butler J, et al. Cardiovascular and renal outcomes with empagliflozin in heart failure. N Engl J Med 2020;383;1413-24.
  62. Gerstein HC, Colhoun HM, Dagenais GR, et al. Dulaglutide and cardiovascular outcomes in type 2 diabetes (REWIND): a double-blind, randomised placebo-controlled trial. Lancet 2019;394:121-30.

Cite this document as follows: Clinical Resource, Drugs for Type 2 Diabetes. Pharmacist’s Letter/Prescriber’s Letter. December 2020.

Related Articles