Diabetes Medications as Monotherapy or Metformin-Based Combination Therapy for Type 2 Diabetes

Maruthur, Nisa M.; Tseng, Eva; Hutfless, Susan; Wilson, Lisa M; Suarez‐Cuervo, Catalina; Berger, Zackary; Chu, Yue; Iyoha, Emmanuel; Segal, Jodi B; Bolen, Shari

doi:10.7326/m15-2650

Cited by 590 publications

(457 citation statements)

References 59 publications

Supporting

Mentioning

385

Contrasting

Unclassified

Order By: Relevance

“…Although, metformin the most significant analogue of biguanides was known for its antidiabetic properties since 1959, it was not commercially available before late 90s. Metformin mechanism involves the reduce of hepatic glucose production, improve insulin sensitivity as well as peripheral glucose utilization 5,16,36,37 . Metformin use in Type 2 DM may be associated with reduced cancer mortality rates.…”

Section: Biguanidesmentioning

confidence: 99%

Diabetes Mellitus: A Review on Pathophysiology, Current Status of Oral Pathophysiology, Current Status of Oral Medications and Future Perspectives

Okur¹,

Karantas²,

Sıafaka³

2017

actapharm

View full text Add to dashboard Cite

Section: Biguanidesmentioning

confidence: 99%

Diabetes Mellitus: A Review on Pathophysiology, Current Status of Oral Pathophysiology, Current Status of Oral Medications and Future Perspectives

Okur¹,

Karantas²,

Sıafaka³

2017

actapharm

View full text Add to dashboard Cite

“…MET decreases blood glucose levels by decreasing hepatic glucose production, decreasing intestinal absorption of glucose, and improving insulin sensitivity by increasing peripheral glucose uptake and utilization. These effects are mediated by the initial activation by MET of AMP-activated protein kinase, a liver enzyme that plays an important role in insulin signaling, whole body energy balance, and the metabolism of glucose and fats [1][2][3][4][5].…”

Section: Introductionmentioning

confidence: 99%

A Validated Stability Indicating Ultra-Performance Liquid Chromatographic Method for Simultaneous Determination of Metformin Hydrochloride and Empagliflozin in Bulk Drug and Tablet Dosage Form

Gopal

Sridhar

2017

Int J App Pharm

View full text Add to dashboard Cite

Objective: To develop a simple, precise, accurate, method was developed and validated for analysis of metformin hydrochloride (MET) and empagliflozin in (EMPA) in bulk and tablet dosage form. Methods:The method used a reverse phase column, dikma C18 (50×2.1 mm, 1.8 μ), a mobile phase comprising of phosphate buffer (pH-3): methanol (30:70 v/v) flow rate of 1.0 ml/min and a detection wavelength of 240 nm using a photodiode array detector. The proposed method was validated for various parameters like linearity, precision, accuracy, robustness, ruggedness, detection, quantification limits, stability studies, formulation analysis as per International Conference on Harmonization (ICH) guidelines. Results:The retention time was found to be 1.189 min and 1.712 min for MET and EMPA respectively. The proposed method was found to be having linearity in the concentration range of 500-2500 μg/ml for MET (r 2 =0.989) and 5-25 μg/ml for EMPA (r 2 =0.994), respectively. The mean % recoveries obtained were found to be 100.35-100.48% for MET and 99.80-101.30% for EMPA respectively. Stress testing which covered acid, base, peroxide, photolytic and thermal degradation was performed on under test to prove the specificity of the method and the degradation was achieved. The developed method has been statistically validated according to International Conference on Harmonization (ICH) guidelines. Conclusion:Thus, the proposed method can be successfully applied for the stability indicating the simultaneous determination of MET and EMPA in bulk and combined tablet dosage form and in the routine quality control analysis.

show abstract

“…Metformin, with perhaps the exception of insulin, has unsurpassed efficacy for HbA 1c reduction, typically in the 1-1.5% range, influenced to some degree by baseline glycemia (24). Whenever it has been compared head-to-head with other drugs, equivalent glycemic reductions have been measured or, in some studies, an actual advantage to metformin has been found (24). Admittedly, however, the degree of HbA 1c reduction may not necessarily be the most important outcome from a medication used for diabetes.…”

mentioning

confidence: 99%

Is It Time to Change the Type 2 Diabetes Treatment Paradigm? No! Metformin Should Remain the Foundation Therapy for Type 2 Diabetes

Inzucchi

2017

Diabetes Care

View full text Add to dashboard Cite

Most treatment guidelines, including those from the American Diabetes Association/European Association for the Study of Diabetes and the International Diabetes Federation, suggest metformin be used as the first-line therapy after diet and exercise. This recommendation is based on the considerable body of evidence that has accumulated over the last 30 years, but it is also supported on clinical grounds based on metformin’s affordability and tolerability. As such, metformin is the most commonly used oral antihyperglycemic agent in the U.S. However, based on the release of newer agents over the recent past, some have suggested that the modern approach to disease management should be based upon identification of its etiology and correcting the underlying biological disturbances. That is, we should use interventions that normalize or at least ameliorate the recognized derangements in physiology that drive the clinical manifestation of disease, in this circumstance, hyperglycemia. Thus, it is argued that therapeutic interventions that target glycemia but do not correct the underlying pathogenic disturbances are unlikely to result in a sustained benefit on the disease process. In our field, there is an evolving debate regarding the suggested first step in diabetes management and a call for a new paradigm. Given the current controversy, we provide a Point-Counterpoint debate on this issue. In the point narrative that precedes the counterpoint narrative below, Drs. Abdul-Ghani and DeFronzo provide their argument that a treatment approach for type 2 diabetes based upon correcting the underlying pathophysiological abnormalities responsible for the development of hyperglycemia provides the best therapeutic strategy. Such an approach requires a change in the recommendation for first-line therapy from metformin to a GLP-1 receptor agonist. In the counterpoint narrative below, Dr. Inzucchi argues that based on the medical community’s extensive experience and the drug’s demonstrated efficacy, safety, low cost, and cardiovascular benefits, metformin should remain the “foundation therapy” for all patients with type 2 diabetes, barring contraindications. —William T. Cefalu Chief Scientific, Medical & Mission Officer, American Diabetes Association

show abstract

Diabetes Medications as Monotherapy or Metformin-Based Combination Therapy for Type 2 Diabetes

Abstract: Agency for Healthcare Research and Quality.

Cited by 590 publications

References 59 publications

Diabetes Mellitus: A Review on Pathophysiology, Current Status of Oral Pathophysiology, Current Status of Oral Medications and Future Perspectives

Diabetes Mellitus: A Review on Pathophysiology, Current Status of Oral Pathophysiology, Current Status of Oral Medications and Future Perspectives

A Validated Stability Indicating Ultra-Performance Liquid Chromatographic Method for Simultaneous Determination of Metformin Hydrochloride and Empagliflozin in Bulk Drug and Tablet Dosage Form

Is It Time to Change the Type 2 Diabetes Treatment Paradigm? No! Metformin Should Remain the Foundation Therapy for Type 2 Diabetes

Contact Info

Product

Resources

About