Pharmacological oral agents for the treatment of type 2 diabetes during Ramadan
| Generic name | Daily dosage (mg) | Advantages | Concerns |
|---|---|---|---|
| Insulin secretagogues | |||
| Sulfonylureas | |||
| Glipizide | 2.5–20 | Lowers HbA1c by 1–2%, high initial response rate, no lag time before response, once-daily dosing, low cost | Hypoglycemia, weight gain, need caution in patients with renal and hepatic dysfunction and with sulfa allergy |
| Glyburide | 1.25–20 | ||
| Glimepiride | 1–4 | ||
| Gliclazide | 40–320 | ||
| Gliclazide MR | 30–60 | ||
| Meglitinides | |||
| Repaglinide | 0.5–8 | Lowers HbA1c by 1–1.5%, shorter half-life than sulfonylureas | Hypoglycemia, weight gain, repeated (before meals) dosing, more expensive than sulfonylureas |
| Nateglinide | 60–120 | ||
| α-Glucosidase inhibitors | |||
| Acarbose | 25–150 | Lowers HbA1c by 0.5–0.8% lowers postprandial glucose levels without causing hypoglycemia, weight neutral | Less effective in lowering glycemia than metformin or sulfonylureas, increased gas production and GI symptoms |
| Miglitol | |||
| Insulin sensitizers | |||
| Biguanides | |||
| Metformin | 500–2000 | Lowers HbA1c by 1–2%,weight neutral, high initial response rate, long record of relative safety, low risk of hypoglycemia, improved lipid profile, may reduce macrovascular events, low cost | Initial GI side effects common, risk of lactic acidosis, cannot be used in patients with renal dysfunction or hepatic dysfunction |
| Thiazolidinediones | |||
| Pioglitazone | 15–45 | Lowers HbA1c by 0.8–1.5%, low risk of hypoglycemia, improved lipid profile | Weight gain, fluid retention causing peripheral edema and/or heart failure, expensive, risk of osteopenia in postmenopausal females |
| Incretin agents | |||
| Dipeptidyl peptidase-4 inhibitors | |||
| Sitagliptin | 25–100 | Lowers HbA1c by 0.6–1%, well tolerated, lowers postprandial glucose levels, weight neutral | More expensive and less potent than metformin and sulfonylureas, some agents require dose adjustment in patients with reduced renal function |
| Linagliptin | 5 | ||
| Saxagliptin | 2.5–5 | ||
| Alogliptin | 12.5–25 | ||
| Anagliptin* | 200–400 | ||
| Teneligliptin* | 20–40 | ||
| Glucagon-like peptide 1 agonists | |||
| Exenatide | 5–10 mcg two times a day | Lowers HbA1c by 0.8–2%, lowers postprandial glucose levels, weight loss, low risk of hypoglycemia, may reduce blood pressure, improved lipid profile | High rate of GI side effects, injectable, more expensive than sulfonylureas and metformin |
| Liraglutide | 0.6–1.8 mg daily | ||
| Exenatide ER | 2 mg weekly | ||
| Dulaglutide | 0.75–1.5 mg weekly | ||
| Albiglutide | 30 mg weekly | ||
| Lixisenatide* | 10 mcg daily | ||
| SGLT-2 inhibitors | |||
| Dapagliflozin | 5–10 mg daily | Lowers HbA1c by 0.8–1.5%, low risk of hypoglycemia, weight loss, lower blood pressure | Increases risk of urinary tract infection and genital infections, expensive, risk of dehydration |
| Canagliflozin | 100–300 daily | ||
*Not Food and Drug Administration approved. ER, extended release; GI, glycemic index; HbA1c, glycated hemoglobin; MR, modified release; SGLT-2, sodium glucose transporter-2.