Biguanides and Sulfonylureas as Combination Therapy in NIDDM

Abstract

Oral combination therapy with biguanides (metformin) and sulfonylureas is discussed. The rationale for the use of this combination is based on the different sites of action of the two kinds of drugs and the possibility for obtaining additive or potentiating effects and reduced side effects. The clinical usefulness of chlorpropamide and glyburide in combination with metformin has been demonstrated in some clinical trials. The combination may provide satisfactory glycemic control for several years, and possibly insulin therapy can be postponed or even avoided. No special safety problems are encountered with the use of the combination other than those attributed to the use of metformin or sulfonylurea alone, i.e., lactic acidosis and hypoglycemia, respectively. The lethality risks of these associated conditions are comparable. It is concluded that more data are needed to evaluate the full clinical potential and the mechanism of action of oral combination therapy.

Glycemic control and cost-effectiveness attained by the drug utilization of oral antidiabetic agents in a tertiary care hospital in South India

“…The rationale being, metformin reduces hepatic gluconeogenesis and decreases insulin resistance while sulfonylurea increases insulin secretions, which counter the two major pathologies in T2DM. 22 Drug utilization showed an increase in utilization of metformin, glimepiride and a reduction in utilization of glibenclamide in contrast to earlier reports where glibenclamide was most utilized. 6 This is due to adherence to changing treatment guidelines, metformin's ability to reduce insulin resistance and weight without causing hypoglycemia.…”

Drug utilization study on antidiabetic medications at SIMS-Shimoga a tertiary care hospital

“…Sex included males and females; marital status included married, unmarried, and widow. Socioeconomic status was based on modified Kuppuswamy score which divided the patients into five categories upper (26-29), upper middle (16-25), lower middle (11)(12)(13)(14)(15), upper lower (5-10), and lower (<5). Literacy was based on the education status as primary, secondary, and higher secondary graduation.…”

Activation of the cAMP-PKA pathway Antagonizes Metformin Suppression of Hepatic Glucose Production

“…Now, over 150 million people worldwide take this medication; guidelines for the treatment of T2D published by the American Diabetes Association and the European Association for the Study of Diabetes in 2012 jointly recommended metformin as the initial drug for T2D treatment (2). Surprisingly, about 35% of diabetic patients either lack or have a delayed response to metformin treatment (3)(4)(5)(6), and many patients become less responsive to metformin over time (4). It remains unknown how metformin resistance/ insensitivity occurs.…”