There is really no best or safest pill for treatment of diabetes, because certain pills (usually called oral antidiabetic drugs or OADs) are appropriate for certain patients but not for others. Therefore, it is important for the prescribing physician to take a number of factors pertaining to the patient into account before recommending a specific OAD or combination of OADs.
Table 4 shows the currently available types of OAD and the main advantages and disadvantages of each. Although therapy must be individually selected for each patient, certain general statements can be made. The newer OADs sitagliptin and saxagliptin, which belong to a class of OADs known as DPP-IV inhibitors, appear to be especially safe, in that sitagliptin does not interact with other drugs (although saxagliptin alters plasma levels of some drugs and needs to be either not used or used with caution when taking these) and do not appear to have any serious side effects. Although a few patients may have experienced serious allergic reactions with sitagliptin, this is a very tiny minority of the many patients who have taken the drug. Which OAD could be considered the best (in the sense of most effective) is quite debatable, because several types of OAD have similar effectiveness and this varies according to the timing of their use in the course of the diabetes.
One must also consider the fact that some OADs tend to fail after a certain time of use, while others have less of a tendency to do so. In addition, some OADs, such as pioglitazone, have other benefits in addition to their effect on blood sugar, such as improving the cholesterol level and lowering blood pressure and perhaps even lowering the rate of heart attacks. Taken together, all this indicates that there is no single best drug for all patients with diabetes, but that for each patient there is one or more OADs that are safest and most effective for him or her.
Abbreviations: ER: extended release; Occ: occasional; TZD: Thiazolidinedione (glitazone); HDL: high density lipoprotein (good cholesterol)
CHF: congestive heart failure; MI: myocardial infarction (heart attack); TG: triglycerides; DPP-IV I: dipeptidyl peptidase IV inhibitor;
URTI: upper respiratory tract infection (e.g., cold); HA: headache; UTI: urinary tract infection; α-glucosidase I: α-glucosidase inhibitor;
CVD: cardiovascular disease; BABR: bile-acid binding resin;
Note: Many combination preparations of these medications are available. Combination use provides convenience and cost savings, but the properties of each of their component medications are unchanged.
*Lactic acidosis is a rare but serious side effect that can be prevented by not using this drug in persons with certain medical conditions.
§Rhinitis is nasal congestion, stuffiness, and runny nose.
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