Combination Therapy: SGLT2i with Metformin
The information below is about prescribing SGLT2i and Metformin together to patients, with the objective to achieve a significant reduction in HbA1c, as well as reap cardiovascular, cerebrovascular and renal benefits for patients with Type 2 Diabetes
- Metformin is a cornerstone in managing type 2 diabetes and effectively lowers blood glucose by reducing hepatic glucose production and improving insulin sensitivity. It is well-tolerated, generally weight-neutral, and has cardiovascular benefits.
- SGLT2 inhibitors are a newer class of diabetes medications that enhance glycemic control by promoting excretion of glucose in urine. They also support weight loss and offer cardiovascular and renal protective benefits. Their unique advantages make them a valuable addition to diabetes treatment regimens.
Clinical Trial Findings
Discussion
- Combining SGLT2i with Metformin appears to lower the risk of DKA, and reduces the chance of metformin-associated lactic acidosis.
- This combination provides a robust approach to managing type 2 diabetes, enhancing glycemic control and offering additional cardiovascular and renal benefits.
- The combination may lead to gastrointestinal side effects from metformin and urinary or genital infections from SGLT2 inhibitors, which can affect adherence.
- Some patients may find the cost of SGLT2 inhibitors a barrier to access. Nevertheless, the benefits are tangible.
Reference: Huang C-Y, Lee J-K. Effects of SGLT2 Inhibitors with and without Metformin in High-Risk, Treatment-Naïve Patients with Diabetes. Journal of Clinical Medicine. 2024; 13(5):1387.
