Oral Hypoglycaemics

Key points

• Metformin (biguanide): first-line in T2DM — ↓ hepatic gluconeogenesis; side effects GI upset, lactic acidosis (avoid if significant renal impairment); stop during acute illness/contrast.
• Sulfonylureas (gliclazide): stimulate insulin release from beta cells — main side effects hypoglycaemia and weight gain.
• Pioglitazone (thiazolidinedione, PPAR-gamma agonist): avoid in heart failure (fluid retention); associated with fractures and bladder cancer signal.
• DPP-4 inhibitors (sitagliptin): weight-neutral, low hypoglycaemia risk.
• SGLT-2 inhibitors (dapagliflozin): promote urinary glucose excretion — side effects UTIs, genital infections, euglycaemic DKA.