Table 1

Trade-offs among existing diabetes drug treatment alternatives

DPP4GLP1INS/BSGLT2SFUTZD
First on market20062005NPH (isophane insulin)1982; Lantus 2000March 20131950s1997
RouteOralInjectionInjectionOralOralOral
Mean A1c-lowering*0.25%–1.0%0.8%–1.5%No limit0.5%–1.0%1.0%–1.5%0.5%–1.5%
HypoglycemiaNoNoYesNoYesNo
Cost†$428–$436$527–$831$165–$355$470$50–$94$349–$355
Body weightNeutral/lossLossGainLossGainGain
Other cautionsKidney disease; ketoacidosis; pancreatitisPancreatitis; thyroid cancer;
gastrointestinal upset
Urine and vaginal infection; kidney disease; fractures; caution elderly ketoacidosisCaution elderlycongestive heart failure; liver disease; edema; fractures
  • *Range of mean A1c reductions from synthesis of multiple trials.9

  • †Range of median wholesale prices for monthly supply.10

  • DPP4, dipeptidyl peptidase-4 inhibitors; GLP1, glucagon-like peptide-1 receptor agonists; INS/B, long-acting or intermediate-acting insulin given as a basal (rather than mealtime) injection; SGLT2, sodium-glucose cotransporter 2 inhibitors; SFU, sulfonylurea or meglitinides; TZD, thiazolidinediones.