Diabetes Monotherapies Versus Metformin-Based Combination Therapy for the Treatment of Type 2 Diabetes

Overview

Journal Int J Gen Med

Publisher Dove Medical Press

Specialty General Medicine

Date 2021 Aug 2

PMID 34335049

Citations 6

Authors

Awadhesh K Singh

Ritu Singh

Partha Pratim Chakraborty

Affiliations

Soon will be listed here.

Abstract

Step-wise addition of antihyperglycemic agents (AHA) after the initiation of metformin monotherapy has been the traditional approach for the treatment of type 2 diabetes mellitus (T2DM) world-wide. Emerging evidence increasingly suggests that metformin-based combination therapy, especially with the newer AHA that lowers HbA1c glucose-dependently and do not potentiate hypoglycemia, could be a potentially better option for durable glycemic control with good tolerability compared to diabetes monotherapy. In this review, we descriptively analyzed the evidence available from the systematic reviews and meta-analyses of randomized head-to-head trials that reported the efficacy and safety outcomes of diabetes monotherapy, metformin-based combination therapies, and monotherapy versus metformin-based combination therapies.

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References

Milder T, Stocker S, Abdel Shaheed C, McGrath-Cadell L, Samocha-Bonet D, Greenfield J . Combination Therapy with an SGLT2 Inhibitor as Initial Treatment for Type 2 Diabetes: A Systematic Review and Meta-Analysis. J Clin Med. 2019; 8(1). PMC: 6352265. DOI: 10.3390/jcm8010045. View

Maruthur N, Tseng E, Hutfless S, Wilson L, Suarez-Cuervo C, Berger Z . Diabetes Medications as Monotherapy or Metformin-Based Combination Therapy for Type 2 Diabetes: A Systematic Review and Meta-analysis. Ann Intern Med. 2016; 164(11):740-51. DOI: 10.7326/M15-2650. View

Wu D, Li L, Liu C . Efficacy and safety of dipeptidyl peptidase-4 inhibitors and metformin as initial combination therapy and as monotherapy in patients with type 2 diabetes mellitus: a meta-analysis. Diabetes Obes Metab. 2013; 16(1):30-7. DOI: 10.1111/dom.12174. View

Davies M, DAlessio D, Fradkin J, Kernan W, Mathieu C, Mingrone G . Management of Hyperglycemia in Type 2 Diabetes, 2018. A Consensus Report by the American Diabetes Association (ADA) and the European Association for the Study of Diabetes (EASD). Diabetes Care. 2018; 41(12):2669-2701. PMC: 6245208. DOI: 10.2337/dci18-0033. View

Haneda M, Noda M, Origasa H, Noto H, Yabe D, Fujita Y . Japanese Clinical Practice Guideline for Diabetes 2016. J Diabetes Investig. 2018; . PMC: 5934251. DOI: 10.1111/jdi.12810. View

Wang Z, Sun J, Han R, Fan D, Dong X, Luan Z . Efficacy and safety of sodium-glucose cotransporter-2 inhibitors versus dipeptidyl peptidase-4 inhibitors as monotherapy or add-on to metformin in patients with type 2 diabetes mellitus: A systematic review and meta-analysis. Diabetes Obes Metab. 2017; 20(1):113-120. DOI: 10.1111/dom.13047. View

Kim N, Lim S, Kwak S, Moon M, Moon J, Lee Y . Efficacy and tolerability of novel triple combination therapy in drug-naïve patients with type 2 diabetes from the TRIPLE-AXEL trial: protocol for an open-label randomised controlled trial. BMJ Open. 2018; 8(9):e022448. PMC: 6157558. DOI: 10.1136/bmjopen-2018-022448. View

Jia W, Weng J, Zhu D, Ji L, Lu J, Zhou Z . Standards of medical care for type 2 diabetes in China 2019. Diabetes Metab Res Rev. 2019; 35(6):e3158. DOI: 10.1002/dmrr.3158. View

Inzucchi S, Lipska K, Mayo H, Bailey C, McGuire D . Metformin in patients with type 2 diabetes and kidney disease: a systematic review. JAMA. 2014; 312(24):2668-75. PMC: 4427053. DOI: 10.1001/jama.2014.15298. View

10.

Salpeter S, Greyber E, Pasternak G, Salpeter Posthumous E . Risk of fatal and nonfatal lactic acidosis with metformin use in type 2 diabetes mellitus. Cochrane Database Syst Rev. 2010; (1):CD002967. DOI: 10.1002/14651858.CD002967.pub3. View

11.

Cheng A . Canadian Diabetes Association 2013 clinical practice guidelines for the prevention and management of diabetes in Canada. Introduction. Can J Diabetes. 2013; 37 Suppl 1:S1-3. DOI: 10.1016/j.jcjd.2013.01.009. View

12.

Cahn A, Cefalu W . Clinical Considerations for Use of Initial Combination Therapy in Type 2 Diabetes. Diabetes Care. 2016; 39 Suppl 2:S137-45. PMC: 5023033. DOI: 10.2337/dcS15-3007. View

13.

Li J, Gong Y, Li C, Lu Y, Liu Y, Shao Y . Long-term efficacy and safety of sodium-glucose cotransporter-2 inhibitors as add-on to metformin treatment in the management of type 2 diabetes mellitus: A meta-analysis. Medicine (Baltimore). 2017; 96(27):e7201. PMC: 5502143. DOI: 10.1097/MD.0000000000007201. View

14.

Cai X, Gao X, Yang W, Han X, Ji L . Efficacy and Safety of Initial Combination Therapy in Treatment-Naïve Type 2 Diabetes Patients: A Systematic Review and Meta-analysis. Diabetes Ther. 2018; 9(5):1995-2014. PMC: 6167297. DOI: 10.1007/s13300-018-0493-2. View

15.

Cersosimo E, Johnson E, Chovanes C, Skolnik N . Initiating therapy in patients newly diagnosed with type 2 diabetes: Combination therapy vs a stepwise approach. Diabetes Obes Metab. 2017; 20(3):497-507. DOI: 10.1111/dom.13108. View

16.

Cosentino F, Grant P, Aboyans V, Bailey C, Ceriello A, Delgado V . 2019 ESC Guidelines on diabetes, pre-diabetes, and cardiovascular diseases developed in collaboration with the EASD. Eur Heart J. 2019; 41(2):255-323. DOI: 10.1093/eurheartj/ehz486. View

17.

Khunti S, Khunti K, Seidu S . Therapeutic inertia in type 2 diabetes: prevalence, causes, consequences and methods to overcome inertia. Ther Adv Endocrinol Metab. 2019; 10:2042018819844694. PMC: 6502982. DOI: 10.1177/2042018819844694. View

18.

Kahn S, Haffner S, Heise M, Herman W, Holman R, Jones N . Glycemic durability of rosiglitazone, metformin, or glyburide monotherapy. N Engl J Med. 2006; 355(23):2427-43. DOI: 10.1056/NEJMoa066224. View

19.

Cherukuri L, Smith M, Tayek J . The durability of oral diabetic medications: Time to A1c baseline and a review of common oral medications used by the primary care provider. Endocrinol Diabetes Metab J. 2018; 2(3). PMC: 6200420. View

20.

. Intensive blood-glucose control with sulphonylureas or insulin compared with conventional treatment and risk of complications in patients with type 2 diabetes (UKPDS 33). UK Prospective Diabetes Study (UKPDS) Group. Lancet. 1998; 352(9131):837-53. View