The 3 most effective oral agents for lowering hemoglobin A1c in diabetic patients are Metformin, Sulfonylureas, and Thiazolidinediones.
MEDICATION, TYPICAL DOSE & ROUTE
1. Biguanides (Metformin) – Decrease A1C ~ 1.5%
Metformin 500 to 1,000 mg PO twice daily – Decreases A1C by ~ 1.5%
2. Sulfonylureas – Decrease A1C ~1.5%
Glimepiride (Amaryl) 1 to 8 mg PO daily
Glipizide (Glucotrol) 5 to 15 mg PO daily
Glyburide 1.25 to 20 mg PO daily
3. Thiazolidinediones – Decreases A1C ~1%
Pioglitazone (Actos) 15 to 45 mg PO daily
Rosiglitazone (Avandia) 4 to 8 mg PO daily
4. Dipeptidyl-peptidase-4 inhibitors – Decrease A1C
Alogliptin (Nesina) 25 mg PO daily
Linagliptin (Tradjenta) 5 mg daily
Saxagliptin (Onglyza) 2.5 to 5 mg daily
Sitagliptin (Januvia) 50 to 100 mg PO daily
5. Glucagon-like peptide-1 receptor agonists
Exenatide (Byetta) 5 to 10 mcg SC twice daily
Exenatide (Bydureon) 2 mg SC once weekly
Liraglutide (Victoza) 1.2 to 1.8 mg SC daily.
Start 0.6mg SC qd x 1wk, then 1.2 mg SC qd; Max 1.8 mg/day. Retitrate from 0.6 mg SC qd if treatment is interrupted for more than 3 days.
6. Meglitinides
Nateglinide (Starlix) 120 mg PO TID before each meal.
Repaglinide (Prandin) 0.5 to 4 mg PO TID 15-30min before each meal
7. Sodium-glucose cotransporter 2 inhibitors
Canagliflozin (Invokana) 100 to 300 mg PO daily
Dapagliflozin (Farxiga) 5 to 10 mg PO qam
8. Alpha-glucosidase inhibitors
Acarbose (Precose) 25 to 100 mg PO three times daily
Miglitol (Glyset) 25 to 100 mg PO three times daily