Is metformin outdated? Will it have a better blood sugar-lowering effect if combined with "Gliptin" as a combination drug?

Some time ago, in the 2022 version of the "ADA/EASD: Consensus on the Management of Hyperglycemia in Type 2 Diabetes (Draft)", GLP1 receptor agonists and SGLT2 inhibitors were recommended more as medications for the treatment of type 2 diabetes. Traditional metformin was rarely mentioned. So many friends asked Huazi, is metformin outdated in the treatment of type 2 diabetes?

Hua Zi said that in the study of diabetes, it was found that two new glucose-lowering drugs had stronger protective effects on organs, so they received more recommendations. However, metformin has not been eliminated. In the treatment of type 2 diabetes, metformin is still a safe and effective oral glucose-lowering drug.

Moreover, in the new round of national centralized drug procurement, the combination preparation of metformin and vildagliptin is also included in the catalog, indicating that metformin has not withdrawn from the first-line anti-diabetic drug.

1. Metformin, which is still strong despite old age

Since its discovery, metformin has been the first choice for type 2 diabetes. And after decades of verification, metformin has a significant blood sugar-lowering effect and low adverse reactions. In the diabetes treatment guidelines of various countries, it is recommended that metformin should always be included in the treatment plan for patients with type 2 diabetes as long as there are no contraindications.

Even though there are now glucose-lowering drugs such as GLP1 receptor agonists and SGLT2 inhibitors, metformin is still the first choice for patients with new diabetes, and its glucose-lowering effect is still reliable. However, the former has a slightly stronger protective effect on organs such as the heart and kidneys, and is more suitable for patients with diabetes with a long course of disease.

2. Vildagliptin, a new blood sugar-lowering drug

Vildagliptin is a highly effective and selective dipeptidyl-peptidase 4 (DPP-4) inhibitor that can delay the metabolism of glucagon-like peptide 1 (GLP1) in the human body. GLP1 is an incretin hormone produced by the human body that stimulates insulin secretion based on blood sugar levels.

Naturally produced GLP1 has a very short duration of action and is metabolized and inactivated by DDP-4 within minutes of production. Vildagliptin inhibits the action of DPP-4, which can prolong the stimulating effect of GLP1 on insulin secretion. Moreover, when blood sugar levels are too low, GLP1 will not work, there is no risk of hypoglycemia, and it is very safe.

3. The hypoglycemic effect is stronger after combined use

From the perspective of pharmacological mechanism, metformin and vildagliptin can complement each other well when used in combination.

Metformin can improve insulin resistance, increase glucose utilization by tissues, reduce the output of liver glycogen, and inhibit the uptake of glucose by intestinal wall cells. It has no obvious hypoglycemic effect on normal people and does not pose a risk of hypoglycemia when used alone for type 2 diabetes. Vildagliptin can promote insulin secretion according to the level of blood sugar.

When blood sugar is still not well controlled after reaching the optimal therapeutic dose of metformin, vildagliptin can be added to further control blood sugar without the risk of hypoglycemia and with fewer adverse reactions.

Combining the two into a compound drug can improve patients' compliance with medication and avoid treatment failure caused by missed medications. Moreover, after Metformin and Vildagliptin Tablets are included in the national centralized procurement catalog, the price of the drug will be greatly reduced, and the drug cost of patients will be greatly reduced.

In summary, metformin is not outdated and is still the first choice for patients with new type 2 diabetes. When metformin reaches the optimal therapeutic dose, if blood sugar is still not controlled to the standard, vildagliptin can be added to further control blood sugar. You can also choose a combination of metformin and vildagliptin to simplify the medication process, improve medication compliance, and better control blood sugar.

Drugs must be used under the guidance of a doctor. If you have any questions about medication, please consult a doctor or pharmacist. I am pharmacist Huazi, welcome to follow me and share more health knowledge.