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Advantages and Disadvantages of the Oral Diabetes Drugs

Our evaluation is based on a recent scientic analysis by the Johns Hopkins University-evidence based Practice Center, along with the Oregon Health and Science University-based Drug Eectiveness Review Project. is is a summary of a longer, more detailed report you can nd at www.CRBestBuyDrugs.org.

Consumer Reports Best Buy Drugs are in blue. We recommend these drugs because they are eective, generally safe, and cost less. Work with your doctor to choose the best drug or drugs for you.


Biguanides generic Metformin


  • Low risk of low blood sugar

  • Does not cause weight gain

  • Drop in triglycerides1

  • No rise in blood pressure

  • Low cost: $4 to $35 per month or less2


  • High risk of nausea, bloating, and diarrhea

  • Not safe for people who have kidney disease

or heart failure

  • Might need to take 2 to 3 times a day

Sulfonylureas generic Glipizide, Glimepiride, and Glyburide

  • Fast-acting

  • No rise in blood pressure or bad (LDL) cholesterol3

  • Take once a day

  • Low cost: $4 to $20 per month or less2

  • Weight gain of 5 to 10 pounds

  • Higher risk of low blood sugar



generic Acarbose

and brand-name Glyset

Low risk of low blood sugar Does not cause weight gain Drop in triglycerides1 No rise in cholesterol

  • Less effective than most other diabetes pills

  • Higher risk of nausea, vomiting, and diarrhea

  • High cost: $78 to $200 per month

Thiazolidinediones brand-names Actos and Avandia,

and generic Pioglitazone

Less risk of low blood sugar than Sulfonylureas Slight rise in good (HDL) cholesterol4 Drop in triglycerides (Actos)

  • Higher risk of heart failure

  • Higher risk of heart attack (Avandia only)

  • Higher risk of bladder cancer (Actos only)

  • Weight gain of 5 to 10 pounds

  • Risk of fluid build-up (edema) and

low blood iron (anemia)

  • Rise in bad (LDL) cholesterol3

  • High cost: $176 to $419 per month

Meglitinides brand-names Prandin and Starlix, and generic Nateglinide

  • Fast-acting

  • No rise in cholesterol

  • Risk of low blood sugar and weight gain of 5 to 10 pounds (Prandin only)

  • Less drop in blood sugar with Starlix than Sulfonylureas

  • High cost: $142 to $347 per month

DPP-inhibitors brand-name Januvia and Onglyza

  • Low risk of low blood sugar

  • Few known side effects (but they are new drugs)

  • Less effective than several other diabetes drugs

  • Less known about potential side effects

compared to older drugs

  • High cost: $275 to $282 per month


Triglycerides are a kind of fat in the blood that can clog the arteries and cause heart disease.

2 A three-month supply of these drugs may cost as little as $10 through programs offered at some chain and independent pharmacies, and some grocery stores. Some programs have restrictions.



LDL cholesterol is a kind of fat that can build up on the walls of blood vessels and contribute to heart disease. HDL cholesterol is called good cholesterol because it helps remove LDL (bad) cholesterol from the blood.

This series is produced by Consumer Reports and Consumer Reports Best Buy Drugs, a public information project supported by grants from the state Attorney General Consumer and Prescriber Education Grant Program which is funded by the multi-state settlement of consumer fraud claims regarding the marketing of the prescription drug Neurontin. This brief should not be viewed as a substitute for a consultation with a medical or health professional. It is provided to enhance communication with your doctor, not replace it.

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