The most effective management of diabetes mellitus demands a multidisciplinary approach, involving both lifestyle modifications with diet and exercise and pharmacologic therapies as necessary to meet individualized glycemic goals. Lifestyle modifications must be combined with oral pharmacologic agents for optimal glycemic control, particularly as type 2 diabetes mellitus progresses with continued loss of pancreatic beta-cell function and insulin production. 
Oral Hypopglycemic Medications
Meglitinides (Repaglinide and nateglinide)
Thiazolidinediones (rosiglitazone, pioglitazone)
α-Glucosidase inhibitors (acarbose, miglitol, voglibose)
DPP-4 inhibitors (sitagliptin, saxagliptin, vildagliptin, linagliptin, alogliptin)
SGLT2 inhibitors (dapagliflozin and canagliflozin)
FDA approved indications for the use of oral hypoglycemic drugs are type 2 diabetes mellitus.
Non-FDA approved indications of some oral hypoglycemic drugs, such as metformin, are for the prevention of type 2 diabetes mellitus, polycystic ovary syndrome with menstrual irregularities, weight loss, gestational diabetes mellitus, and prevention of ovarian hyperstimulation syndrome.
The following are adverse effects of various hypoglycemic drugs:
Sulfonylureas: Syncope (less than 3%), dizziness (2% to 7%), nervousness (4%), anxiety (less than 3%), depression (<3%), hypoesthesia (less than 3%), insomnia (<3%), pain (<3%), paresthesia (less than 3%), drowsiness (2%), headache (2%), diaphoresis (less than 3%), pruritus (1% to less than 3%), hypoglycemia (less than 3%), increased lactate dehydrogenase, diarrhea (1% to 5%), flatulence (3%), dyspepsia (less than 3%), and vomiting (less than 3%).
Repaglinide: Hypoglycemia (16% to 31%), weight gain, headache (9% to 11%), upper respiratory tract infection (10% to 16%), and cardiovascular ischemia (4%).
Metformin: Gastrointestinal upset such as diarrhea (12% to 53%), nausea and vomiting (7% to 26%), flatulence (4% to 12%), chest discomfort, flushing, palpitation, headache (5% to 6%), chills, dizziness, taste disorder, diaphoresis, nail disease, skin rash, decreased vitamin B12 serum concentrate. Also in less than 1 % of patients it metformin causes cholestasis and lactic acidosis.
Thiazolidinediones: Edema (less than or equal to 27%), hypoglycemia (less than or equal to 27%), cardiac failure (less than or equal to 8%), headache, bone fracture (less than or equal to 5%), myalgia (5%), sinusitis (6%), and pharyngitis.
Alpha-glucosidase inhibitors: Flatulence (74%) that tends to abate with time, diarrhea (31%), abdominal pain (19%), and increased serum transaminases (less than or equal to 4%).
SGLT-2 inhibitors: Dyslipidemia (3%), hyperphosphatemia (2%), hypovolemia (1%), nausea, fungal vaginosis (7% to 8%), urinary tract infection (6%), increased urine output (3% to 4%), dysuria (2%), influenza (2% to 3%), bone fracture (8%), and renal impairment.
Cycloset: Dizziness, fatigue, headache, constipation, rhinitis, nausea, and weakness.
The following are contraindications for different classes of oral hypoglycemic drugs.
Oral hypoglycemic agents are often prescribed by the primary care provider, nurse practitioner, endocrinologist and internist. However, it is important to educate the patient on changes in lifestyle. A dietary consult should be sought to educate the patient on a healthy diet. The patient should be urged to join an exercise program, stop smoking and lower the body weight. No matter what oral hypoglycemic agent is prescribed, the healthcare worker must know adverse effects and potential for interaction with other medications.
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