3. DRUGHYPOGLYCE MIA RISK ~A1C REDUCTI ON WEIGH T CHANG E ADVANTAGESDISADVANTAGES/ SIDE EFFECTS METFOR MIN No1.0 – 2.0%LOSSDecreased CV events and mortality; Cost Effective $ GI intolerance ; B12 Def; Lactic Acidosis ; Avoid if Creat >1.4-1.5 TZD (Actos; Avandia) No1.0 – 1.5%GAINNo hypoglycemia Raises HDL Lowers Triglycerides Weight Gain & Edema; Mod Bone Loss LDL increase; Heart Failure Extreme caution with heart disease $$$ DPP -4i (Januvia; Onglyza; Tradjenta) No0.5 – 0.8%NeutralWeight Neutral No Hypoglycemia Potential for Pancreatitis $$$ GLP- 1 RA (Byetta; Bydureon; Victoza; Tanzeum) No0.5 – 1.0%LOSSWt Loss ~2-3kg Improved Beta Cell Fxn BID injection(Byetta) Nausea $$$ SGLT2 (Farxiga; Invokana) No0.9 – 1.2%LOSSComplimentary to other agents including insulin Weight Reduction – significant Lower’s B ~5ptsP Increased genital mycotic infections & UTI’s ; Avoid in pt’s with active Bladder Cancer; Volume Depletion Hypotension Elevated Creat and ?LDL Contraindicated eGFR <30(I) - <60(F) $$$$

4. DRUGHYPOGLYCE MIA RISK ~A1C REDUCTI ON WEIGHT CHANGE ADVANTAGESDISADVANTAGES/ SIDE EFFECTS Amylin Agonist (Pramlintide/ Symlin) YES0.5 – 0.7%LOSS~ 1-1.5 Kg wt loss Reduces insulin requirements TID injection Nausea Hypoglycemia( w/insulin use) $$$ Colesevelam (Welchol) No0.5%NeutralLowers Glucose without Hypoglycemia Lowers LDL $$$-$$$$ GI Separate dosing to prevent binding SFU/ GLINIDES (Glipizide/Glucotr ol; Glyburide/Diabet a/ Micronase; Glimepiride/Amar yl) YES~1.5%GAINWell tolerated Cost Effective $ Hypoglycemia Weight Gain Meglitineides (Starlix; Prandin) YES~1.5%YESEnhanced effects at meals Hypoglycemia Wt Gain Freq Dosing (qac) AGI (Acarbose/Preco se; Miglitol/Glyset) No0.5 – 0.8%NeutralLocal action Decrease pp glucose $$ Gi intolerance Dosing Frequency (TID Dosing) Cycloset (Bromocriptine) No0.6%NeutralCV Safety No Hypoglycemia EARLY AM DOSING Nausea; Decreasing eff of Neuroleptic agents & Psychotic meds; May cause Ortho Hypotension; Increased somulence; $$$