Comprehensive Oral Diabetes Medication Resource 2022

Abstract

Many oral medication classes are available for the treatment of diabetes. Within each class, there are multiple agents with specific indications, side effects, dosing, warnings, and contraindications. The purpose of this article is to provide a quick reference to these medications for use in day-today practice.

Recommendations from the 2022 American Diabetes Association (ADA) Standards of Care regarding oral diabetes therapies highlight the use of sodium-glucose cotransporter-2 inhibitors (SGLT-2) as a possible first-line option in the treatment of type 2 diabetes. Metformin remains first-line for the majority of people, but additive or alternative therapies may be considered if additional compelling indications, such as chronic kidney disease, heart failure, or atherosclerotic cardiovascular disease, are present and data regarding benefit exist, regardless of baseline A1C. The 2022 ADA Standards of Care also suggest patient-centered therapy selection (eg, past medical history, cost, access considerations).

The SGLT-2 inhibitors (canagliflozin, dapagliflozin, empagliflozin, ertugliflozin) were originally approved by the Food and Drug Administration (FDA) for the treatment of type 2 diabetes to lower blood glucose in conjunction with healthy eating and physical activity. Since their initial approval, some of these agents have received additional FDA-approved indications based on randomized controlled trials (see reference list).

Canagliflozin is also approved to reduce risk of major cardiovascular (CV) events in persons with type 2 diabetes with established cardiovascular disease (CVD) and to reduce risk of end-stage renal disease (ESRD), doubling of serum creatinine, CV death, and hospitalization for heart failure in persons with type 2 diabetes and diabetic nephropathy with albuminuria.

Empagliflozin is also approved to reduce the risk of CV death and hospitalization for heart failure in adults with heart failure and to reduce the risk of CV death in adults with type 2 diabetes and established CVD. Although not approved at this time to reduce the risk of ESRD and other renal indications, empagliflozin is being studied in this population, and the trial was stopped early due to potential benefit.

Dapagliflozin is approved to reduce the risk of hospitalization for heart failure in adults with type 2 diabetes and either established CVD or multiple CV risk factors, to reduce the risk of CV death and hospitalization for heart failure in adults with heart failure with reduced ejection fraction even without diabetes (New York Heart Association Class II-IV), and to reduce the risk of sustained estimated glomerular filtration rate (eGFR) decline, ESRD, CV death, and hospitalization for heart failure in adults with chronic kidney disease at risk of progression.

Although canagliflozin previously held a black box warning for risk of lower-limb amputations due to the results of the Canagliflozin and Cardiovascular and Renal Events in Type 2 Diabetes study (CANVAS Program), other studies have not substantiated the risk of amputation with canagliflozin specifically. The black box warning was removed in fall 2020, although package labeling still holds a general warning. Increased risk of lower extremity amputations has been seen for ertugliflozin, and general warnings for amputation risk exist in its labeling as well.

Table 1 is a quick reference to the most current oral medications for the treatment of type 2 diabetes. It provides drug information regarding dosing, common side effects, indications, clinical pearls, and an update on recent changes and approvals.

Table 1

Oral Medications for the Treatment of Diabetes^a

Category/ drug names	Mechanism of action	Indication	Dosage, frequency, and administration	Side effects	Contraindications/warnings	Clinical pearls
Biguanide
Metformin (Glucophage) Metformin extended release (Glucophage XR, Fortamet, Glumetza) Liquid metformin (Riomet)	Decreases hepatic glucose production	First-line for many individuals with type 2 diabetes	Metformin 500-1000 mg 2-3 times daily with meals Max dose: 2550 mg/d Metformin XR: 500- 2000mg once daily Max dose: 2000 mg/d Riomet: 500-255 0mg 2-3 times daily Max dose: 2550 mg (25.5 mL) in adults and 200 0mg (20 mL) in pediatric patients (10 to 16 y)	Diarrhea, nausea, abdominal pain, metallic taste Lactic acidosis is a severe though very rare complication (50% fatal) Long-term/high-dose use of metformin may cause vitamin B12 deficiency	Before starting therapy, obtain eGFR eGFR > 60 mL/min/1.73m²: no adjustment necessary eGFR > 45 to < 60 mL/ min/1.73m²: no dosage adjustment necessary, monitor renal function every 3-6 mo eGFR 30 to 45 mL/min/1.73m²: initiation not recommended; reduce dose to 500 mg twice daily eGFR < 30 mL/min/1.73m²: use is contraindicated People who drink alcohol more than 2-4 drinks a wk (increases risk lactic acidosis)	A1C lowering 1%-2% Take with food to decrease GI side effects. Slow upward titration of dose may decrease GI side effects. Measure vitamin B12 levels every 1 to 2 y, low levels may contribute to peripheral neuropathy. Max antihyperglycemic dose is 2000 mg/d.
Sulfonylurea (SFU)
Glipizide (Glucotrol) Glipizide extended release (Glucotrol XL)	Increases insulin secretion from pancreatic beta cells	Type 2 diabetes in addition to meal planning and physical activity to lower blood glucose	Glipizide: 2.5-40 mg take 30 min before the 1st meal of the day Max dose: 40 mg/d Glipizide XL: 2.5-20 mg once daily Max dose: 20 mg/d	Hypoglycemia Weight gain	Severe hypoglycemia when caloric intake omitted/reduced Do not use XL if stricture or GI tract narrowing Glyburide has active metabolites and may increase risk of hypoglycemia in elderly	A1C lowering: 1%-2% Inexpensive Do not break/crush/ chew XL tablets. Most clinical efficacy occurs at half-max dose. May have reduced effect over time (requires pancreatic insulin production). Avoid glyburide in age > 65 y due to risk of hypoglycemia. May have reduced effect over time (requires pancreatic insulin production).
Glyburide (Diabeta, Glynase Prestabs)			Glyburide 1.25-20 mg daily Max dose: 20 mg/d PresTabs 0.75-12 mg daily Max dose: 12 mg/d
Glimepiride (Amaryl)			Glimepiride: 1-8 mg once daily Max dose: 8 mg/d
Meglitinide
Repaglinide (Prandin)	Increases insulin secretion from pancreatic beta cells (insulin secretion is glucose-dependent)	Type 2 diabetes in addition to meal planning and physical activity to lower blood glucose	Repaglinide: 0.5-4mg 1530 min before meals Max dose: 16 mg/d	Hypoglycemia Weight gain	Co-administration of clopidogrel (max repaglinide dose 4 mg/d if must be used), cyclosporine (max repaglinide dose 6 mg/d), gemfibrozil (contraindication), CYP2C8 inhibitors (eg, montelukast), and CYP3A4 inhibitors (eg, ketoconazole) may increase repaglinide levels increasing risk of hypoglycemia. Coadministration of CYP3A4 and/or CYP2C8 inducers (eg, carbamazepine) may decrease repaglinide levels decreasing efficacy.	A1C lowering 0.5% Lowers postmeal blood glucose only.
Nateglinide (Starlix)			Nateglinide 60-120 mg 3 times daily 1-30 min before meals Max dose: 120 mg 3 times daily	Hypoglycemia Weight gain		Skip the dose if skipping the meal. May have reduced effect over time (requires pancreatic insulin production).
Thiazoledinedione (TZD)
Pioglitazone (Actos)	Bind to peroxisome proliferator activated receptor gamma inside cells to improve insulin sensitivity	Type 2 diabetes in addition to meal planning and physical activity to lower blood glucose	Pioglitazone: 15-45 mg once daily Max dose: 45 mg/d	Weight gain, edema due to sodium, and water retention Increased risk of fractures	HF: Actos is not recommended in patients with symptomatic HF. Initiation in patients with established NYHA Class III or IV HF is contraindicated. Fluid retention may occur and can worsen or cause congestive heart failure. Use with insulin and use in patients with HF NYHA Class I and II may increase risk. Hepatic effects: Obtain liver enzymes before starting. If abnormal, use pioglitazone with caution and DC if ALT > 3 times upper limit of normal. Do not initiate rosiglitazone if ALT > 2.5 times upper limit of normal, and DC if ALT > 3 time upper limit of normal. Bladder cancer: may increase risk of bladder cancer Macular edema: Postmarketing reports have shown an increase risk. CYP2C8 inhibitors increase pioglitazone concentrations, limit to 15 mg/d (eg, gemfibrozil)	A1C lowering 1%-2% Takes up to 12 wk to see full benefit. May be taken without regard to meals.
Rosiglitazone (Avandia)			Rosiglitazone: 4-8 mg once daily Max dose: 8 mg/d as a single daily dose or in a divided dose of twice daily
Alpha glucosidase inhibitor
Acarbose (Precose)	Blocks the enzyme responsible for breaking down complex carbohydrates in the intestine. This enzyme inhibition results in a delayed glucose absorption and a lowering of postprandial hyperglycemia.	Type 2 diabetes in addition to meal planning and physical activity to lower blood glucose	Acarbose: 25-100 mg 3 times daily at the start of each main meal Max dose: 50 mg 3 times daily for patients < 60 kg and 100 mg 3 times daily for patients > 60 kg	Flatulence Diarrhea Abdominal pain Bloating	Acarbose may increase liver transaminase levels, which is usually dose related and more common in females. Do not take acarbose if serum creatinine > 2 mg/dL or CrCl < 25mL/min, Contraindicated in inflammatory bowel disease, colonic ulceration, intestinal obstruction,	A1C lowering 0.6%-0.7% Increased hypoglycemia risk if also taking sulfonylureas or insulin. Hypoglycemia should be treated with glucose or lactose (milk) whose metabolism are not blocked by acarbose or miglitol. Foods made of sucrose-like table sugar, hard candy, juice or, regular soda will not work. Skip the medication if not eating. Patients with low body weight may be at increased risk for elevated liver enzymes.
Miglitol (Glyset)			Miglitol: 25-100 mg 3 times daily at the start of each main meal Max dose: 100 mg 3 times daily	Flatulence Diarrhea Abdominal pain Bloating	Avoid using in patients with CrCl < 25mL/min due to causing serum levels of miglitol to double,
Dipeptidyl peptidase-4 (DPP-4) inhibitor
Sitagliptin (Januvia) Saxagliptin (Onglyza) Linagliptin (Tradjenta) Alogliptin (Nesina)	Inhibition of DPP-4 blocks the degradation of glucagon-like peptide 1 allowing extended incretin action,	Type 2 diabetes in addition to meal planning and physical activity to lower blood glucose	Sitagliptin: Initial and max dose: 100 mg/d Saxagliptin: Initial dose: 2.5 to 5mg once daily: Max dose: 5 mg/d Linagliptin: Initial and max dose: 5 mg/d Alogliptin: Initial and max dose: 25 mg once daily	Upper respiratory tract infection Nasopharyngitis Headache Allergic reactions like skin rash, itching, or hives	Postmarketing reports of: Pancreatitis Increased hospitalizations for HF: observed in clinical trials with alogliptin and saxagliptin Bullous pemphigoid requiring hospitalization; if suspected, discontinue the DPP-4 inhibitor Severe and disabling arthralgia Acute renal failure, sometimes requiring dialysis	A1C lowering 0.5%-0.8% renal dosing: Sitagliptin: 50 mg once daily when eGFR > 30 to < 45 mL/min/1.73m² 25 mg once daily when eGFR < 30 ml/min/1.73 m² Saxagliptin: 2.5 mg once daily when eGFR < 45 mL/min/1.73 m² (or if taking strong CYP3A4 inhibitor, eg, ketoconazole) Linagliptin: No dose adjustment is recommended for patients with kidney or liver impairment. Alogliptin: 12.5 mg once daily when CrCl > 30 to < 60 mL/min 6.25 mg once daily for patients when CrCl < 30 mL/min
Bile acid sequestrant
Colesevelam (Welchol) tablets and oral suspension	Mechanism of action regarding glucose control not fully understood. Lowers blood glucose levels via mechanism that is associated with increased incretin secretion and improved beta cell function but not with reduced gluconeogenesis or glucose absorption.	Type 2 diabetes in addition to meal planning and physical activity to lower blood glucose	Colesevelam: Initial and max dose: tablets: 6 tablets once daily or 3 tablets twice daily; should be taken with a meal and liquid Initial and max dose: oral suspension: one 3.75-g packet once daily or one 1.875-g packet twice daily. Empty the entire contents of one packet into a glass or cup. Add V2 to 1 cup (4-8 oz) of water, fruit juice, or diet soft drinks. Stir well and drink. Oral suspension should be taken with meals. To avoid esophageal distress, oral suspension should not be taken in its dry form.	Constipation Dyspepsia Nausea	Do not use in patients with a history of bowel obstruction. Do not use in patients with serum triglyceride > 500 mg/dL. Do not use in patients with a history of hypertriglyceridemia-induced pancreatitis. May decrease absorption of fat-soluble vitamins.	A1C lowering 0.5% May decrease the GI absorption of some drugs. Administer drugs with a known interaction with colesevelam at least 4 h prior. Postmarketing reports: Increased seizure activity or decreased phenytoin levels in patients receiving phenytoin; administer phenytoin 4 hours prior to Welchol.
Dopamine agonist
Bromocriptine (Cycloset)	Dopamine receptor agonist; affects circadian rhythm and leads to increased insulin sensitivity and glucose disposal	Type 2 diabetes in addition to meal planning and physical activity to lower blood glucose	Dose range: 1.6-4.8 mg/d based on tolerance and glucose lowering effect Initial dose is 1 tablet (0.8mg) daily increased weekly by 1 tablet. Max dose: 4.8mg/d Take within 2 h after waking in the morning with food	Nausea Fatigue Headache Vomiting Hallucinations Somnolence	Do not use in patients with syncopal migraines. May precipitate hypotension; caution in patients taking antihypertensives. Do not use in nursing women; may inhibit lactation. Postmarketing reports of stroke Avoid in patients with severe psychotic disorders.	A1C lowering 0.5% May exacerbate psychotic disorders or reduce the effectiveness of drugs that treat psychosis. Limit dose to 1.6 mg daily during concomitant use of a moderate CYP3A4 inhibitor. Avoid concomitant use with strong CYP3A4 inhibitors.
Glucagon-like peptide-1 receptor agonist (glp-1 ra)
Semaglutide (Rybelsus)	Increases glucose- dependent insulin secretion, slows gastric emptying, promotes satiety, suppresses glucagon,	Adjunct to diet and exercise to improve glycemic control in adults with type 2 diabetes	Initial dose: 3 mg once daily (should be taken on an empty stomach with no more than 4 oz of plain water, wait 30-60 min to eat, drink, or take other medications) for 30 d, then may increase to 7 mg once daily, then if additional glycemic control needed after 30 d, may increase to 14 mg once daily Max dose: 14 mg/d	Nausea/ abdominal pain Vomiting Diarrhea/ constipation Decreased appetite Hypo-glycemia when combined with insulin or insulin secreta-gogues	Risk of thyroid C-cell tumors; contraindicated in people with personal or family history of medullary thyroid carcinoma Increased risk of pancreatitis Increase risk of diabetic retinopathy; patients with a history should be monitored Postmarketing reports of acute renal failure and worsening of chronic renal failure	A1C lowering 1.2%-1.4% Conversion between formulations: Rybelsus 14 mg daily can be converted to subcutaneous Ozempic 0.5 mg once weekly started the day after the last dose of Rybelsus; Ozempic 0.5 mg subcutaneous injection can be converted to Rybelsus 7 or 14 mg started up to 7 d after the last Ozempic dose Do not split/crush/chew.
Sodium-glucose cotransporter-2 (SGLT-2) inhibitor
Canagliflozin (Invokana) Empagliflozin (Jardiance) Dapagliflozin (Far xiga) Ertugliflozin (steglatro)	Inhibits SGLT-2 in the proximal convoluted tubules of the kidney, reducing glucose reabsorption and increasing urinary glucose excretion	Treatment of type 2 diabetes in addition to meal planning and physical activity to lower blood glucose Canagliflozin only: to reduce risk of major CV events (CV death, nonfatal MI, or nonfatal stroke) in adults with type 2 diabetes and established CVD; to reduce risk of end-stage renal disease, doubling of SrCr, CV death, and hospitalization for HF in adult patients with type 2 diabetes and albuminuria > 300 mg/d Empagliflozin only: to reduce risk of CV death in adults with type 2 diabetes and established CVD; to reduce the risk of CV death and hospitalization for HF in adults with HF (10 mg/d) Dapagliflozin only: to reduce risk of hospitalization for HF in adult patients with type 2 diabetes and established CVD or multiple CV risk factors; to reduce the risk of CV death and hospitalization for HF in adults with HFrEF (10 mg/d); to reduce the risk of sustained eGFR decline, end stage renal disease, CV death, and hospitalization for HF in adults with CKD at risk for progression (10 mg/d)	Canagliflozin: 100 mg Max dose: 300 mg/d Empagliflozin: 10 mg Max dose: 25 mg/d Dapagliflozin: 5 mg Max dose: 10 mg/d Ertigliflozin: 5 mg Max dose: 15 mg/d	Genital mycotic infections, urinary tract infections, and increased urination Hyper- sensitivity reactions Increased LDL Increase risk of acute kidney injury and pyelonephritis for all agents (assess volume status prior to initiation, especially if risk factors (eGFR < 60 mL/ min/1.73 m², elderly, concomitant loop diuretics) Hypotension	Dialysis Increased risk of bone fracture for canagliflozin Increased risk of lower extremity amputations seen in clinical trials for ertugliflozin and canagliflozin	A1C lowering 0.7%-1% Renal dosing: Canagliflozin: 100 mg once daily when eGFR 3059 mL/min/1.73m² Initiation not recommended but may continue 100 mg once daily if albuminuria > 300 mg/d when eGFR < 30mL/min/1.73m² Empagliflozin: Not recommended for glycemic control when eGFR < 30 mL/ min/1.73m² (limited efficacy) Dapagliflozin: Initiation not recommended but may continue 10 mg once daily to reduce risk of eGFR decline, end stage renal disease, CV death, and hospitalization for HF Ertugliflozin: Not recommended when eGFR < 45 mL/min/1.73m² Advise patient to drink plenty of water and stay hydrated Hold prior to surgery (3 d-canagliflozin, empagliflozin, dapaglifozin; 4 d-ertugliflozin) Increased risk of euglycemic DKA if used in patients with type 2 diabetes injecting insulin and in patients with type 1 diabetes Recommend good hygiene practices to reduce risk of genital mycotic infections

Footnotes for Table 1

Sources are listed in the following:

Glucophage [package insert]. Bristol-Myers Squibb; 2018.

Glucophage XL [package insert]. Bristol-Myers Squibb; 2018.

Lalau J-D, Farshad K, Bennis Y, Hurtel-Lemaire A-S, Belpaire F, De Broe ME. Metformin treatment in patients with type 2 diabetes and chronic kidney disease stages 3A, 3B, or 4. Diabetes Care. 2018;41:547-553. doi:10.2337/dc17-2231

Riomet [package insert]. Ranbaxy; 2008.

Glucotrol [package insert]. Pfizer; 2008.

Glucotrol XL [package insert]. Pfizer; 2006.

Diabeta [package insert]. Sanofi-Aventis Canada; 2016.

Glynase Prestab [package insert]. Pfizer; 2009.

Amaryl [package insert]. Sanofi-Aventis US; 2009.

Rosenstock J, Kahn SE, Johansen OE, et al. Effect of linagliptin vs glimepiride on major adverse cardiovascular outcomes in patient with type 2 diabetes. JAMA. 2019;322(12):1155-1166. doi:10.1001/jama.2019.13772

Prandin [package insert]. Novo Nordisk; 2019.

Starlix [package insert]. Novartis; 2018.

Actos [package insert]. Takeda; 2011.

Neal B, Perkovic V,Mahaffey KW, et al. Canagliflozin and cardiovascular and renal events in type 2 diabetes. N Engl J Med. 2017;377:644-657 doi:10.1056/NEJMoa1611925

Avandia [package insert]. GlaxoSmithKline; 2020.

Precose [package insert]. Bayer Healthcare; 2015.

Glyset [package insert]. Bayer Healthcare; 2016.

Januvia [package insert]. Merck; 2021.

Onglyza [package insert]. Bristol-Myers Squibb; 2019.

Tradjenta [package insert]. Boehringer Ingelheim; 2022.

Nesina [package insert]. Takeda; 2016.

Welchol [package insert]. Daiichi Sankyo; 2020.

Cycloset [package insert]. VeroScience; 2020.

Rybelsus [package insert]. Novo Nordisk; 2021.

Invokana [package insert]. Janssen; 2020.

Jardiance [package insert]. Boehringer Ingelheim; 2022.

Farxiga [package insert]. AstraZeneca Pharmaceuticals LP; 2021.

Steglatro [package insert]. Merck; 2021.

Heerspink HJL, Stefansson BV, Correa-Rotter R, et al. Dapagliflozin in patients with chronic kidney disease. N Engl J Med. 2020;383:1436-146. doi:10.1056/NEJMoa2024816

Wiviott SD, Raz I, Bonaca MP, et al. Dapagliflozin and cardiovascular outcomes in type 2 diabetes. N Engl J Med. 2019;380:347-357 doi:10.1056/NEJMoa1812389

Zinman B, Wanner C, Lachin HM, et al. Empagliflozin, cardiovascular outcomes, and mortality in type 2 diabetes. N Engl J Med. 2015;373:2117-2128. doi:10.1056/NEJMoa1504720

McMurray JJV, Solomon SD, Inzucchi SE, et al. Dapagliflozin in patients with HF and reduced ejection fraction. N Engl J Med. 2019;381:1995-2008. doi:10.1056/NEJMoa1911303

Perkovic V, Jardine MJ, Neal B, et al. Canagliflozin and renal outcomes in type 2 diabetes and nephropathy. N Engl J Med. 2019;380:2295-2306. doi:10.1056/NEJMoa1811744

New combination products have become available on the market and are included in Table 2. These include Synjardy XR (empagliflozin, metformin) and Trijardy XR (empagliflozin, metformin, linagliptin). Both of these combination products are dosed once daily.

Table 2

Combination Oral Medications for the Treatment of Diabetes

Brand name	Generics	When to take
ACTOplus met	Pioglitazone & metformin	2-3 times daily with meals
ACTOplus met XR	Pioglitazone & metformin extended release	Once daily with evening meal
Duetact	Pioglitazone & glimepiride	One daily with first meal
Glucovance	Glyburide & metformin	1-2 times daily with meals
Glyxambi	Empagliflozin & linagliptin	Once daily
Invokamet	Canagliflozin & metformin	Twice daily with meals
Invokamet XR	Canagliflozin & metformin	Once daily with first meal
Janumet	Sitagliptin & metformin	Twice daily with meals
Janumet XR	Sitagliptin & metformin	Once daily with first meal
Jentadueto	Linagliptin & metformin	Twice daily with meals
Kazano	Alogliptin & metformin	Twice daily with meals
Kombiglyze XR	Saxagliptin & metformin	Once daily with evening meal
Metaglip	Glipizide & metformin	Twice daily with meals
Oseni	Alogliptin & pioglitazone	Once daily with or without food
Prandimet	Repaglinide & metformin	2-3 times daily 15-30 minutes before meals
Qtern	Dapagliflozin & saxagliptin	Once daily in morning
Qternmet XR	Dapagliflozin, saxagliptin, & metformin	Once daily in morning with food
Segluromet	Ertugliflozin & metformin	Twice daily with meals
Steglujan	Ertugliflozin & sitagliptin	Once daily in morning
Synjardy	Empagliflozin & metformin	Twice daily with meals
Synjardy XR	Empagliflozin & metformin	Once daily in morning
Trijardy XR	Empagliflozin, linagliptin, & metformin	Once daily with morning meal
Xigduo XR	Dapagliflozin & metformin	Once daily with first meal

You are encouraged to remove the tables from the journal and keep them handy for reference. ■

Footnotes

Acknowledgements

Tables originally prepared by Tommy Johnson, PharmD, CDE, BC-ADM, FAADE, Presbyterian College School of Pharmacy, Clinton, SC; and Marilyn Cox, PharmD, BCPS, CDCES, Kaiser Permanente, Baltimore, MD. Updated by Amanda Stahnke, PharmD, BCACP, University of Missouri-Kansas City School of Pharmacy, Kansas City, MO.

Duality of Interest

Diana Issacs is a consultant to Sanofi and Eli Lilly and serves on the speaker’s bureaus of Abbott, Dexcom, Medtronic, Insulet, and Novo Nordisk. Joanne Rinker is employed by MannKind. Marilyn Cox is employed by Kaiser Permanente. Kathryn Holt and Amanda Stahnke declare having no professional or financial association or interest in an entity, product, or service related to the content or development of this article.

Funding

The authors declare having received no specific grant from a funding agency in the public, commercial, or not-for-profit sectors related to the content or development of this article.

Kathryn M. Holt, PharmD, BCPS is with University of Missouri in Kansas City, MO. Diana M. Isaacs, PharmD, BCPS, BCACP, BC-ADM, CDCES, FADCES, FCCP is with the Cleveland Clinic Endocrinology & Metabolism Institute in Cleveland, OH. Joanne Rinker, MS, RDN, CDCES, LDN, FADCES is with MannKind Corporation in Waynesville, NC. Marilyn A. Cox, PharmD, BCPS, CDCES is with Kaiser Permanente in Baltimore, MD. Amanda M. Stahnke, PharmD, BCACP is with University of Missouri in Kansas City, MO.

References

Heerspink

HJL

Stefansson

Correa-Rotter

, et al. Dapagliflozin in patients with chronic kidney disease. N Engl J Med. 2020;383:1436-1446. doi:10.1056/NEJMoa2024816

Lalau

J-D

Farshad

Bennis

Hurtel-Lemaire

A-S

Belpaire

De Broe

. Metformin treatment in patients with type 2 diabetes and chronic kidney disease stages 3A, 3B, or 4. Diabetes Care. 2018;41:547-553. doi:10.2337/dc17-2231

McMurray

JJV

Solomon

Inzucchi

, et al. Dapagliflozin in patients with HF and reduced ejection fraction. N Engl J Med. 2019;381:1995-2008. doi:10.1056/NEJMoa1911303

Perkovic

Jardine

Neal

, et al. Canagliflozin and renal outcomes in type 2 diabetes and nephropathy. N Engl J Med. 2019;380:2295-2306. doi:10.1056/NEJMoa1811744

Rosenstock

Kahn

Johansen

, et al. Effect of linagliptin vs glimepiride on major adverse cardiovascular outcomes in patient with type 2 diabetes. JAMA. 2019;322(12):1155-1166. doi:10.1001/jama.2019.13772

Wiviott

Raz

Bonaca

, et al. Dapagliflozin and cardiovascular outcomes in type 2 diabetes. N Engl J Med. 2019;380:347-357. doi:10.1056/NEJMoa1812389

Zinman

Wanner

Lachin

, et al. Empagliflozin, cardiovascular outcomes, and mortality in type 2 diabetes. N Engl J Med. 2015;373:2117-2128. doi:10.1056/NEJMoa1504720