Insulin

InterventionsExpecteddecrease inHbA1c (%)AdvantagesDisadvantagesSteps 1: initialLifestyle to decrease weightand increase activityMetformin 1.5 Weight neutral,inexpensiveStep 2: additional therapy1-2 Low cost, many benefits Fails for most in first yearInsulin 1.5-2.5 No dose limit, inexpensive,improved lipid profileGI side effects, rare lacticacidosisInjections, monitoring,hypoglycaemia, weight gainaSulfonylureas 1.5 Inexpensive Weight gain, hypoglycaemiaTZDs 0.5-1.4 Improved lipid profile Fluid retention, weight gain,expensiveOther drugsα -Glucosidase inhibitors 0.5-0.8 Weight neutral Frequent GI side effects, threetimes/ day dosing, expensiveExenatide 0.5-1.0 Weight loss Injections, frequent GI sideeffects, expensive, littleexperienceGlinidesb1-1.5 Short duration Three times/day dosing,expensivePramlintide 0.5-1.0 Weight loss Injections, three times/daydosing, frequent GI side effects,expensive, little experience