Metformin makes the body more responsive to insulin , while sitagliptin works to lower elevated blood sugars.
Dr. Debora E. Williams-Herman of Merck Research Laboratories, Rahway, New Jersey and colleagues write in the journal Diabetes Care that, “Because sitagliptin and metformin lower blood sugar through different, but potentially complementary, mechanisms the combination should provide effective, potentially additive, blood sugar control,”

To investigate, they randomized 1,091 type 2 diabetics to sitagliptin plus metformin, metformin alone, sitagliptin alone or inactive placebo. At the start of the study, the average A1C level -- a common measure of blood sugar control -- was 8.8 percent, which is considered high.

All patients on active treatment had "meaningful" reductions in blood sugar levels compared with those on placebo. At 24 weeks, 66 percent of patients treated with sitagliptin and metformin had an A1C of less than 7 percent, and 44 percent of this group reached a value of less than 6.5 percent.

This was significantly better than results with a single drug, the team notes, and "demonstrated an additive response."
There was a low incidence of hypoglycemia, or low blood sugar, which was not significantly different from that in the placebo group.

This study shows that the combination of sitagliptin and metformin provides "substantial and additive" improvement in blood sugar levels and is "generally well tolerated," the team concludes.
Diabetes Care, August 2007
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