Consider DPP-4 inhibitors like sitagliptin or linagliptin. These medications enhance insulin release and reduce glucagon secretion, improving blood sugar control. They generally have a lower risk of hypoglycemia than sulfonylureas like glipizide, but may cause upper respiratory infections in some patients.
SGLT2 Inhibitors: A Closer Look
SGLT2 inhibitors, such as empagliflozin or canagliflozin, work by increasing glucose excretion in the urine. This leads to lower blood glucose levels and can also offer cardiovascular benefits, including reduced risk of hospitalization for heart failure. However, they can increase the risk of urinary tract infections and may cause weight loss.
GLP-1 Receptor Agonists: Weight Management and More
Liraglutide or semaglutide belong to the GLP-1 receptor agonist class. These medications improve insulin secretion, suppress glucagon, and slow gastric emptying. Significant weight loss is a common benefit, making them attractive for patients with obesity. Potential side effects include nausea and vomiting, though these often subside.
Medication Comparison Table
| DPP-4 Inhibitors | Sitagliptin | Enhances insulin, reduces glucagon | Improved blood sugar, low hypoglycemia risk | Upper respiratory infections |
| SGLT2 Inhibitors | Empagliflozin | Increases glucose excretion | Lower blood glucose, cardiovascular benefits | Urinary tract infections, weight loss |
| GLP-1 Receptor Agonists | Liraglutide | Improves insulin, suppresses glucagon, slows gastric emptying | Improved blood sugar, weight loss | Nausea, vomiting |
TZD’s: A Different Approach
Thiazolidinediones (TZDs) like pioglitazone improve insulin sensitivity in peripheral tissues. This can be beneficial for improving blood glucose levels. However, they carry a risk of fluid retention and weight gain, and may not be suitable for all patients due to potential liver effects.
