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Treatment of type 2 diabetes: inadequate assessment of oral antidiabetic combinations

    Prescrire International
    |February 27, 2003
    PubMed

    Insights

    Metformin and glibenclamide are key for type 2 diabetes, but often insufficient. Combining them with other oral antidiabetics may increase mortality, despite guideline recommendations.

    Area of Science:

    • Endocrinology
    • Metabolic Diseases
    • Pharmacology

    Background:

    • Metformin and glibenclamide are primary oral antidiabetics for type 2 diabetes complications.
    • Monotherapy with these agents frequently fails to meet HbA1c targets below 7%.

    Purpose of the Study:

    • To evaluate the efficacy and safety of combining oral antidiabetics when monotherapy fails.
    • To review clinical guidelines recommending metformin and sulfonylurea combinations despite limited evidence.

    Main Methods:

    • Analysis of existing randomized trials and clinical guidelines.
    • Assessment of comparative efficacy and mortality data for oral antidiabetic combinations.

    Main Results:

    • A single randomized trial indicated higher mortality with metformin and sulfonylurea combination compared to sulfonylurea monotherapy.
    • Despite this, current clinical guidelines often recommend this combination for persistent hyperglycemia.

    Conclusions:

    • There is a lack of robust data supporting specific combination strategies for type 2 diabetes.
    • Shared decision-making with patients is crucial, discussing all options including monotherapy continuation or insulin initiation.

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