Clinical implications of diabetes in chronic liver disease: Diagnosis, outcomes and management, current and future perspectives

Table 4 Kinetics, metabolism and excretion of the currently available anti-hyperglycaemic drugs[102]

Drug	Half life	Metabolism	Excretion
Short-acting insulins
Human	140 min	Proteolytic degradation
Lyspro	80 min	Proteolytic degradation
Aspart	80 min	Proteolytic degradation
Glulisine	80 min	Proteolytic degradation
Long-acting insulins
Human-NPH	6.6 h	Proteolytic degradation
Glargine	12.1 h	Proteolytic degradation
Levemir	5-7 h	Proteolytic degradation
Degludec	25 h	Proteolytic degradation
Glargine-300	19 h	Proteolytic degradation
Sulfonylureas
Glibenclamide	10 h	Liver 100%	Urines 50%; feces 50%1
Glimepiride	9 h	Liver 100%	Urines 60%; feces 40%1
Gliclazide	10-11 h	Liver 100%	Urines 80%; feces 20%
Glipizide	2-5 h	Liver 90%	Urines mainly
Meglitinides
Repaglinide	1 h	Liver 100%	Bile 92%; urines 8%
Biguanides
Metformin	1.5-3 h	Not metabolised	Urines 100%
Thiazolidinediones
Pioglitazone	3.7 h	Liver 100%	Feces 55%; urines 45%
DPP-4 inhibitors
Sitagliptin	8–24 h	Limited	Urines
Vildagliptin	1.5–4.5 h	Limited	Urines
Saxagliptin	2–4 h	Moderate	Urines
Linagliptin	10–40 h	Extensive	Feces
Alogliptin	12–21 h	Limited	Urines
GLP-1RAs
Exenatide	2.4 h	Proteolytic degradation	Renal
Liraglutide	13 h	Proteolytic degradation	No specific organ
Lixisenatide	3 h	Proteolytic degradation	Renal
Exenatide LAR	5-6 d	Proteolytic degradation	Renal
Dulaglutide	5 d	Proteolytic degradation	No specific organ
Semaglutide	7 d	Proteolytic degradation	No specific organ
α-glicosidase inhibitors
Acarbose	4 h	Intestine	Urines 35%; feces 65%
SGLT2 inhibitors
Dapaglifozin	10-13 h	Glucuronidation	Urines 33%; feces 42%
Canaglifozin	12.9 h	Glucuronidation	Urines 75%; feces 21%
Empaglifozin	12.4 h	Glucuronidation	Urines 54%; feces 41%
Ertugliflozin	17 h	Glucuronidation	Urines 50%; feces 41%

¹Excreted as weakly active metabolite.

DPP-4: Dipeptidyl peptidase 4; GLP-1RAs: Glucagon-like peptide 1 receptor agonists; SGLT2: Sodium-glucose cotransporter 2; LAR: Long-acting release; NPH: Neutral protamine Hagedorn.