Diabetes treatment


Initial therapy choice (insulin vs stepped approach)


Stepped approach


First-line in all diabetics
  • ADA recommendation First-line therapy in all diabetics who do not have a contraindication
  • Cost: Very cheap and used for many years
  • Effect: Average A1C reductions of 1%
  • Hypoglycemia: Does not cause hypoglycemia by itself
  • Side effects: Causes gastrointestinal side effects (up to 40%) that typically improve with time
Preferred second-line in diabetics with CVD (or high risk for CVD), heart failure, or chronic kidney disease
SGLT2 inhibitors
  • ADA recommendation Preferred second-line therapy in patients with CVD (or high risk), heart failure, and/or chronic kidney disease
  • Cost: Expensive. See SGLT2 inhibitor PAP for information on how qualified patients may obtain for free.
  • Effect: Average A1C reductions around 0.7 - 1%
  • Hypoglycemia: Does not cause hypoglycemia by itself
  • Side effects: Yeast infections (1 - 12%), UTIs (4 - 10%), and diuresis
Preferred second-line in diabetics with CVD (or high risk for CVD)
GLP-1 analogs
  • ADA recommendation Preferred second-line therapy in patients with CVD or multiple risk factors for CVD. GLP-1 analogs may be beneficial in overweight patients because they can promote weight loss.
  • Cost: Expensive. See GLP-1 analog PAP for information on how qualified patients may obtain for free.
  • Effect: Average A1C reductions around 0.7 - 1.6%. Can promote weight loss (semaglutide > liraglutide > dulaglutide > exenatide > lixisenatide)
  • Hypoglycemia: Does not cause hypoglycemia by itself
  • Side effects: Nausea (12 - 40%), diarrhea (8 - 15%), and vomiting (5 - 15%)
Other treatments
Sulfonylureas (e.g. glipizide, glyburide)
  • ADA recommendation: Second-line therapy
  • Cost: Very cheap and used for many years
  • Effect: Average A1C reductions of 1 - 1.5%
  • Hypoglycemia: May cause hypoglycemia
  • Side effects: Minimal side effects besides hypoglycemia
Glitazones (Actos, Avandia)
  • ADA recommendation: Second-line therapy
  • Cost: Very cheap and used for many years
  • Effect: Average A1C reductions around 0.7 - 0.9%
  • Hypoglycemia: Does not cause hypoglycemia by itself
  • Side effects: May cause weight gain and fluid retention. Should be avoided in heart failure.
  • Other: May improve nonalcoholic steatohepatitis
Insulin therapy
  • ADA recommendation: Second-line therapy. Insulin should be considered for first-line therapy in patients with ongoing catabolism (weight loss), if symptoms of hyperglycemia are present, or when A1C is > 10% or blood glucose levels > 300 mg/dL.
  • Cost: Cheap options exist (see insulin costs)
  • Effect: Has no maximum effect. Can be titrated to blood sugar goals.
  • Hypoglycemia: Can cause hypoglycemia.
  • Side effects: Typically none besides hypoglycemia
  • Other: May require frequent blood sugar monitoring. Patient or caregiver must understand how to inject properly.
DPP-4 inhibitors
  • ADA recommendation: Second-line therapy
  • Cost: Expensive. See DPP-4 inhibitor PAP for information on how qualified patients may obtain for free.
  • Effect: Average A1C reductions of 0.4 - 0.7%
  • Hypoglycemia: Does not cause hypoglycemia by itself
  • Side effects: Generally well tolerated
Other therapies (not generally recommended)

Insulin therapy


Insulin Reduced cost programs Free programs
Basaglar, Humalog,
Humulin N, Humulin R,
Humalog Mix 50/50, Humalog Mix 75/25
Lilly Insulin Value Program
  • Insurance: with and without
  • Cost: $35 for a month supply
  • Eligibility requirements: none
Lilly Cares program
  • Income < 400% of federal poverty level
  • U.S. legal resident
  • No insurance
Lantus, Toujeo, Admelog, Apidra Sanofi Insulin Value Savings Program
  • Insurance: without
  • Cost: $99/month for up to 10 packs of pens and/or vials
  • Eligibility requirements: none
Sanofi Patient Connection
  • Income < 400% of federal poverty level
  • U.S. legal resident
  • No insurance
Levemir, Tresiba, Novolog, Fiasp
Novolin N, Novolin R,
Novolin 70/30, Novolog Mix 70/30
My$99Insulin Program
  • Insurance: with and without
  • Cost: $99/month for up to 3 vials or 2 packs of pens
  • Eligibility requirements: none
NovoCare Patient Assistance Program
  • Income < 400% of federal poverty level
  • U.S. legal resident
  • No insurance
NPH and Regular Walmart
  • Insurance: with and without
  • Cost:
    • Novolin N - $25/vial and $43 for 5 pens
    • Novolin R - $25/vial
  • Eligibility requirements: none
NovoCare Patient Assistance Program
  • Products: Novolin N and R vials only
  • Income < 400% of federal poverty level
  • U.S. legal resident
  • No insurance

Lilly Cares program
  • Products: Humulin N and R
  • Income < 400% of federal poverty level
  • U.S. legal resident
  • No insurance

Insulin dosing



SGLT2 inhibitor Patient Assistance Program Information
Canagliflozin (Invokana®, Invokamet®, Invokamet® XR)
Dapagliflozin (Farxiga®, Qtern®, Xigduo XR®)
Empagliflozin (Jardiance®, Glyxambi®,Synjardy®, Synjardy® XR)
Ertugliflozin (Steglatro®)
  • Manufacturer: Merck
  • Eligibility criteria: Does not have program currently

GLP-1 analog Patient Assistance Program Information
Albiglutide (Tanzeum™)
Dulaglutide (Trulicity™)
Exenatide (Bydureon®, Byetta®)
Liraglutide (Victoza®)
Liraglutide (Saxenda®)
Lixisenatide (Adlyxin®)
Semaglutide (Ozempic®)
Semaglutide (Rybelsus®)

DPP-4 inhibitor Patient Assistance Program Information
Alogliptin (Nesina®, Oseni®, Kazano®)
Linagliptin (Tradjenta®, Glyxambi®,Jentadueto®,Jentadueto® XR)
Saxagliptin (Onglyza®, Kombiglyze® XR, Qtern®)
Sitagliptin (Januvia®, Janumet®, Janumet® XR)