What is the therapeutic role and blood glucose lowering capability of bromocriptine and cholestyramine for the treatment of Type 2 diabetes?

In the 15 or so years since bromocriptine and cholestyramine were approved for the treatment of hyperglycemia in T2DM, I have never prescribed them for this indication. I also have very rarely used other FDA-approved glucose-lowering agents including meglitinides, alpha-glucosidase inhibitors and amylin. Compared to other available treatment options, these agents have pretty unfavorable potential benefits to risk profiles. Some are cumbersome to take in terms of frequent dosing or the requirement of injections.

I also rarely prescribe TZDs, DPP-4is, or sulfonylureas. I pretty much limit these agents to patients who can't afford or tolerate preferred alternative agents.

From a practical standpoint, the only agents I currently am recommendin...

Cycloset is a weakly effective drug, will lower A1C levels by 0.3 to 0.5 percent when taken alone or in combination with a sulfonylurea. It is different than bromocriptine since it is in a rapidly released formulation takes within two hours of waking up.

However, it lowers insulin resistance and in 1 study lowered the composite of cardiovascular events by 55%.