Optimizing Glycemic Control in Type 2 Diabetes: A Review of Metformin-Based Combination Regimens
Abstract
Background: Type 2 Diabetes Mellitus (T2DM) is a prevalent chronic metabolic disorder characterized by persistent hyperglycemia, contributing to significant morbidity and mortality worldwide. While metformin remains the first-line pharmacologic treatment, the complex nature of T2DM often necessitates combination therapy to optimize glycemic control and minimize adverse effects. Objective: This review aims to evaluate the combined effects of metformin with various classes of antidiuretic agents on key clinical parameters, including glycemic control, weight changes, and hypoglycemia incidence in patients with T2DM. Methods: A comprehensive review of recent clinical trials and meta-analyses was conducted, focusing on the efficacy and safety profiles of metformin when combined with DPP-4 inhibitors, SGLT-2 inhibitors, GLP-1 receptor agonists, sulfonylureas, and insulin. Comparative analysis was performed regarding glycemic outcomes, impact on body weight, and hypoglycemia risk. Results: Findings indicate that metformin combined with DPP-4 inhibitors, SGLT-2 inhibitors, or GLP-1 receptor agonists significantly improves and sustains glycemic control, with added benefits of weight reduction or neutrality and a low incidence of hypoglycemia. Conversely, combinations of metformin with sulfonylureas or insulin also enhance glycemic management but are associated with increased risk of hypoglycemia and weight gain in some patients. Conclusions and Recommendations: Individualized treatment selection is critical in determining the optimal combination therapy to enhance clinical outcomes while minimizing adverse effects in T2DM. Further long-term studies are warranted to explore new combinations and their impacts on patient quality of life and disease progression.
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