Issue 153 Item 11 Metformin-Glipizide Combo Is More Effective Than Monotherapy I

A single-tablet combination of metformin and glibenclamide is more effective at lowering blood glucose than is monotherapy with either drug. Antihyperglycaemic effects of the combination therapy are greatest in patients with hemoglobin A1c (HbA1c) equal to or above 8% at baseline, according to investigators, but its advantage over either monotherapy is irrespective of baseline HbA1c, age or body mass index.

The investigators, from multiple international institutions including Baylor College of Medicine and The Methodist Hospital in Houston, Texas, United States, and Hôpital Bichat in Paris, France, studied 1,856 patients from 3 randomized, double-blind, multi-centre, parallel-group clinical trials. Patients were stratified at baseline by HbA1c levels, age and body mass index, and the efficacy of the study treatments were evaluated for each subgroup.

Results showed that the combination therapy was more effective than either monotherapy irrespective of baseline HbA1c, age or body mass index. Patients with baseline HbA1c at 8% or higher experienced the greatest antihyperglycemic effects with all treatments, but especially with the combination therapy.

Age and body mass index had no effect on the efficacy of the metformin-glibenclamide combination.

Hypoglycemic symptoms were greatest in patients who had baseline HbA1c lower than 8%. Hypoglycemic symptoms did not increase with age.

The investigators conclude that the combination therapy has a greater blood glucose lowering efficacy than monotherapy. It is well tolerated in patients with hyperglycemia that has been inadequately controlled by diet and exercise. Diabetes Obes Metab 2003;5:3:171-179

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DO YOU KNOW The HHS guidelines state that patients aged 45 years or older with normal fasting plasma glucose levels or normal results on oral glucose tolerance tests should be retested every 3 years. Those with glucose in the prediabetes range should be counseled on diet and exercise and be retested every 1-2 years to avert progression to diabetes.