Diabetes		Glyburide and Metformin
Blood Sugar; Diabetes Mellitus; Non-Insulin Dependent Diabetes Mellitus; Type II Diabetes		Glucovance

Pictures

Diabetes Medication Warnings Glyburide Metformin

Several times daily medications to handle my Type 2 Diabetes These are the warning labels on the bottles Fun stuff Lately the medication hasn t been working consistently It looks as if insulin might be another option UPDATE 20080108 Diagnosed now as type 1 on insulin pump and have never felt better A1C at 6 1 with an average glucose of 109 SWEET

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By Laura Watson a recent study proves that avandia is better at slowing the progress of type 2 diabetes than metformin or glyburide A new study shows that Avandia a drug manufactured by drug manufacturing giant GlaxoSmithKline slows down the progression of type 2 diabetes in diabetics with the form of the disease Two

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patients with type 2 diabetes continuing on glyburide therapy switched to metformin or given metformin as add on therapy to glyburide Data from

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patients with type 2 diabetes continuing on glyburide therapy switched to metformin or given metformin as add on therapy to glyburide Data from

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hexylurea Glyburide is a white to off white crystalline compound with a molecular formula of C23H28ClN3O5S and a molecular weight of 494 00 The structural formula is represented below Metformin hydrochloride is an oral antihyperglycemic drug used in the management of type 2 diabetes Metformin hydrochloride N N dimethylimidodicarbonimidic diamide monohydrochloride is not

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8 both of the pathophysiologic defects that are contributing to the hypoglycemia are present and therefore combination therapy addressing these multiple defects will be more appropriate Slide Glyburide Metformin Initial Therapy Mean Final Doses A study was recently undertaken comparing glyburide as monotherapy metformin as monotherapy with two different dosage strengths of

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of symptomatic hypoglycemia in patients taking the lowest strength combination tablet was the same as metformin and placebo if the initial HbA1c at entry into the study was above 8 Slide Glyburide Metformin Open Label Initial Therapy for HbA1c >11 or FPG >240 mg dL There were no episodes of severe hypoglycemia And I should add that the incidence of gastrointestinal

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Initial Therapy Change from Baseline HbA1c Mean=8 2 Patients taking the combination therapy achieved a significantly lower HbA1c than those taking either drug alone as monotherapy Slide Metformin Glyburide Initial Therapy Distribution of HbA1c at 20 Weeks And indeed more than 66 of those taking the combination therapy achieved a HbA1c of less than 7 Slide

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drugs when combined were less than when given as monotherapy and that 61 of the patients taking the 1 25 mg 250 mg strength of glyburide metformin received one to two tablets per day Slide Metformin Glyburide Initial Therapy Change from Baseline HbA1c Mean=8 2 Patients taking the combination therapy achieved a significantly lower HbA1c than those taking either drug

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Slide Metformin Glyburide Initial Therapy Distribution of HbA1c at 20 Weeks And indeed more than 66 of those taking the combination therapy achieved a HbA1c of less than 7 Slide Glyburide Metformin Initial Therapy Postprandial Glucose Excursion This next graph shows the PPG excursions in subjects at baseline and at the end of the study The bottom of each bar

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significantly reduced in the metformin and the glyburide metformin combination treatment groups when compared with a placebo and glyburide alone shown on the right hand side of the graphic Slide Glyburide Metformin Initial Therapy Frequency of Hypoglycemic Symptoms This graphic summarizes the percent of patients reporting symptoms of hypoglycemia The frequency of symptomatic

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Sulfonylurea and Metformin Combination Therapy Effect on HbA1c In this next graphic the combination of glyburide and metformin was more effective than either glyburide or metformin alone Slide Mean Change in HbA1c and FPG at Week 12 Produced by Addition of Repaglinide to Metformin Similarly if we add repaglinide to patients taking metformin we will obtain an additional

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levels This usually results in some improvement but generally we fail to reach our goal despite the addition of the second drug after some length of time of treating patients with one drug Slide Sulfonylurea and Metformin Combination Therapy Effect on HbA1c In this next graphic the combination of glyburide and metformin was more effective than either glyburide or metformin

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® 7 pioglitazone hydrochloride Actos® 8 rosiglitazone malate Avandia® 9 acarbose Precose® Glucobay® 10 miglitol Glyset® The actions of sulfonylureas and meglitinides involve the stimulation of insulin secretion metformin suppresses hepatic glucose production the

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of Repaglinide to Metformin Similarly if we add repaglinide to patients taking metformin we will obtain an additional lowering of the FPG and HbA1c by 40 mg dL and 1 4 respectively Slide Mean Change in HbA1c and FPG at Week 26 Produced by Addition of Rosiglitazone to Sulfonylurea In the next graphic we see that if rosiglitazone RSG is added to sulfonylurea SU

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Slide The Evolution of Diabetes Therapy Addressing Multiple Defects Richard S Beaser MD So accepting the trend for more aggressive therapies how do we select specific medications Earlier

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A new study comparing three major diabetes drugs Avandia Glucophage metformin and Micronase glyburide shows that all three drugs have pros and cons to consider Patients and their

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additive effect as shown here combination of metformin and pioglitazone shown on the left of the graphic and combination of metformin and rosiglitazone shown on the right of the graphic Slide Metformin and Acarbose Combination Therapy Effect on HbA1c And finally metformin and alpha glucosidase inhibitors have been used in combination with some degree of success

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to Sulfonylurea And the same is true in the next graphic for pioglitazone Pio Note that in both of these studies utilizing thiazolidinediones submaximal doses of these drugs were used Slide Metformin and Thiazolidinedione Combined Therapy Effect on HbA1c If we combine two sensitizers from different classes we will also produce an additive effect as shown here

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used in combination with some degree of success Unfortunately using the approach of sequentially adding one agent to another has not resulted in the treatment goals recommended by the ADA Slide Proposed New Treatment Paradigm for Type 2 Diabetes And so I would propose a new treatment paradigm All patients should follow a diet and exercise program receive intensive diabetes

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