1. Metformin is recommended first line for most type 2 patients.
2. Sulphonylureas have a more immediate effect at reducing blood glucose levels in symptomatic patients and may also be first choice for insulin-deficient individuals.
3. Sulphonylureas, glitazones and insulin may all cause weigth gain and obesity is often already a problem.
4. Sulphonylureas may put the patient at risk of hypoglicemia with implications for driving.
5. There appears to be increased risk of distal fractures in women using glitazones.
6. Glitazones may cause fluid retention, exacerbating or precipitating heart failure.
7. Exenatide may assist with weight reduction.
8. Sitaglipin is licensed for triple therapy (with metformin and a sulphonylurea) but vildagliptin is currently only licensed for use in combination with one of these other agents.
9. Failure of the HbA1c to respond to exenatide of a gliptin after an appropriate interval requires withdrawal of the drug.
regards, taniafdi ^_^
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