Comparison of medications for the management of hyperglycemia in the hospital setting
| Medication | Advantages | Disadvantages |
|---|---|---|
| Insulin | Extensive experience with glycemic control Protocols widely available Easy to adjust in the event of hypoglycemia, changes in nutrition, diagnostic procedures, or reduced kidney function | Hypoglycemia Common source of hospital errors Requires injection |
| GLP-1-based therapy | Good glucose-lowering effect Low risk for hypoglycemia Nonglycemic beneficial effects | Limited data on safety and efficacy Gastrointestinal side effects Injectable |
| Metformin | Good glucose-lowering effect Low risk for hypoglycemia Inexpensive Oral route | Limited experience Risk of lactic acidosis in patients with impaired kidney function, heart failure, hypoxemia, alcoholism, cirrhosis, contrast exposure, surgery, and shock Gastrointestinal side effects |
| Sulfonylureas | Good glucose-lowering effect Inexpensive Oral route | Risk for hypoglycemia especially in patients with reduced oral intake or impaired renal function. |
| Thiazolidinediones | Good glucose-lowering effect Low risk of hypoglycemia Oral route | Slow onset of action Contraindicated in patients with heart failure and hepatic dysfunction Fluid retention |
| Bromocriptine-quick release | Low risk of hypoglycemia Oral route | No studies in the hospital Risk of hypotension, dizziness |
| Colesevelam | Low risk of hypoglycemia Oral route | No studies in the hospital Constipation |
| DPP-4-inhibitors | Modest glucose-lowering effect Low risk of hypoglycemia No major side effects reported in pilot trial Oral route | Limited experience Contraindicated in patients with history of pancreatitis |
| SGLT-2-inhibitors | Good glucose-lowering effect Low risk of hypoglycemia Oral route | Limited experience Increase risk of urinary and genital tract infections Risk of dehydration, hypotension |
DPP-4 = dipeptidyl peptidase-4; GLP-1 = glucagon-like peptide-1; SGLT-2= sodium-glucose cotransporter-2.