When choosing diabetes treatment: caution with comorbid conditions

Thyroid cancer (including medullary thyroid carcinoma)

Avoid GLP-1 receptor agonists and GLP-1/GIP agonists

Gastroparesis or severe GI disorders

Avoid

• GLP-1 receptor agonists, GLP-1/GIP agonists

• pramlintide (amylin analog)

Genital infections or recurrent UTIs

Avoid SGLT2 inhibitors

Heart failure

Avoid:

• TZDs PIOGLITAZONE

• and use caution or avoid alogliptin and saxagliptin

High hypoglycemia risk

Avoid or minimize:

• insulin

• sulfonylureas

• meglitinides

• pramlintide

Hypotension or dehydration

Avoid SGLT2 inhibitors

Hypokalemia

Use insulin cautiously

Risk of ketoacidosis

Avoid or use extreme caution with SGLT2 inhibitors

Lactic acidosis risk (renal impairment, alcoholism, hypoxia)

Avoid metformin

Osteopenia or osteoporosis

Avoid canagliflozin, bexagliflozin, and TZDs PIOGLITAZONE

Pancreatitis history or risk

Avoid:

• DPP-4 inhibitors

• GLP-1 receptor agonists, and GLP-1/GIP agonists

Peripheral neuropathy, PAD, or foot ulcers

Avoid canagliflozin and bexagliflozin

Severe sulfa allergy

Avoid sulfonylureas or use great caution

Renal insufficiency (eGFR or CrCl less than 30 mL/min)

avoid

• metformin

• exenatide

• glyburide

• start insulin at a lower dose if needed

Weight gain or obesity

Avoid

• sulfonylureas

• meglitinides

• TZDs

• insulin