For people with diabetes, how can metformin be used in combination with other hypoglycemic drugs?

A friend asked Huazi how to use hypoglycemic drugs together. If too many drugs are used at the same time, will there be any adverse effects? What should be paid attention to? Huazi said that the harm of diabetes to the human body is mainly the complications caused by high blood sugar, so the use of hypoglycemic drugs to control blood sugar is the focus of treatment for diabetic patients.

Among diabetic patients, about 10% have type 1 diabetes, which is caused by absolute insulin deficiency and can only be treated by injecting insulin. However, more than 90% of type 2 diabetes patients have absolute or relative insulin deficiency or insulin resistance in peripheral tissues, which can be treated with oral medications.

1. Metformin is still the first choice. When blood sugar is abnormal, the first thing to do is to improve your lifestyle, reduce the total calories of your diet on the basis of ensuring balanced nutrition, increase your exercise, and maintain a normal weight. However, if lifestyle improvements cannot bring blood sugar levels up to standard, drug treatment is needed.

Although many new drugs for the treatment of type 2 diabetes have emerged in recent years, metformin is still the drug of choice in various diabetes treatment guidelines. As long as there are no related contraindications, it is recommended to keep metformin in the treatment plan. Start with a low dose and gradually increase to the optimal therapeutic dose of 2000 mg per day.

2. "Dual therapy" of hypoglycemic drugs 1. Combination of metformin and α-glucosidase inhibitors: α-glucosidase inhibitors such as acarbose and voglibose can delay the absorption of glucose. The combination of acarbose and metformin is the most commonly used hypoglycemic treatment. It is especially suitable for a diet with rice, noodles and other carbohydrate foods as the staple food, and has a good control effect on postprandial blood sugar increase.

2. Combination use of metformin and thiazolidinediones: Thiazolidinediones such as rosiglitazone and pioglitazone can increase the sensitivity of peripheral tissues to insulin. They are more effective for patients with type 2 diabetes who have normal insulin secretion but are obese and have severe insulin resistance, and are less likely to experience hypoglycemia.

3. Combination use of metformin and insulin secretagogues: Insulin secretagogues include sulfonylureas and glinides, which can be used in combination with metformin.

Sulfonylurea drugs such as glibenclamide, glimepiride, gliquidone, glipizide, and gliclazide can stimulate pancreatic β cells to secrete insulin and are suitable for patients with type 2 diabetes who have lost a lot of weight after using metformin. Meglitinides such as repaglinide and nateglinide can reduce postprandial blood sugar by stimulating the early phase secretion of insulin.

4. Metformin can be used in combination with SGLT2 inhibitors: Canagliflozin, Empagliflozin, Dapagliflozin and other SGLT2 inhibitors can lower blood sugar by promoting the excretion of glucose from urine. SGLT2 inhibitors can excrete sodium ions while excreting sugar, and are suitable for patients with type 2 diabetes combined with hypertension, heart failure and renal insufficiency.

5. Metformin can be used in combination with glucagon-like peptide-1 (GLP-1) receptor agonists: liraglutide, dulaglutide, benaglutide and other drugs, which can directly stimulate GLP-1 receptors, increase insulin secretion, delay gastric emptying, suppress appetite and reduce food intake, produce a blood sugar lowering effect, and are suitable for patients with high cardiovascular risk.

6. Metformin can be used in combination with gliptins (DPP-4 inhibitors): vildagliptin, alogliptin, sitagliptin, saxagliptin and other gliptins, which inhibit DPP-4, increase the level of endogenous glucagon-like peptide-1 (GLP-1) in the human body, and produce a hypoglycemic effect. They are suitable for patients with high cardiovascular risk.

3. What to do if you cannot tolerate metformin? The above are combination medications based on metformin. If you cannot tolerate metformin, you can choose gliflozin or gliptin as the basic medication, and then combine it with other hypoglycemic drugs for combination treatment.

Hypoglycemic drugs can also be used for "triple therapy", that is, three drugs with different hypoglycemic mechanisms are selected for combined treatment. If triple therapy still cannot effectively control blood sugar, insulin treatment is recommended. When using insulin treatment, insulin secretagogues such as sulfonylureas and glinides need to be discontinued.

To sum up, patients with type 2 diabetes can use multiple drugs to control blood sugar, which can play a synergistic role, better control blood sugar, and better protect the heart, kidneys, eyes and other organs. However, combined medication is more likely to cause adverse reactions such as hypoglycemia than monotherapy, so medication should be used with caution. The safest approach is to use the drug 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.