There are several classes of diabetes medications that treat diabetes through different mechanisms. In some cases, a single medication can be used to treat someone with type 2 diabetes. On the other hand, not every diabetic is well-controlled on just one blood-sugar lowering medication. For this reason, there are medications that combine two different types of diabetes medications into a single pill. Each medication has a unique mechanism of action, which has advantages when it comes to controlling blood sugar levels. What are some diabetes medication combinations that doctors commonly use?
Metaglip and Glucovance
Metaglip is a combination of two diabetes medications, glipizide and metformin. Glipizide is in the class of medications called sulfonylureas, which work by stimulating the pancreas to produce more insulin and by decreasing glucose production by the liver. The second component of this diabetes medication combination, metformin, works by increasing a cell’s sensitivity to insulin and by blocking glucose production by the liver. This medication can cause nausea, diarrhea, low blood sugars, headache and increases the risk of vitamin B12 deficiency. It shouldn’t be used by anyone with kidney disease, severe liver disease or people who are elderly.
Glucovance is another diabetes medication combination that combines another sulfonylurea, glyburide, with metformin. It has similar risks and side effects to Metaglip.
Duetact and Avandryl
Duetact combines the sulfonylurea, glimepiride, with pioglitazone, a member of a class of diabetes medications known as thiazolidinediones. The thiazolidinediones decreases insulin resistance in muscle and fatty tissue while reducing production of glucose by the liver. When combined with the sulfonylurea, glimepiride, it reduces blood sugar levels more than either drug does alone. This diabetes medication combination can cause weight gain, low blood sugars, nausea, anemia, dizziness and fluid retention. It shouldn’t be used by anyone who has liver disease.
Another diabetes medication called Avandaryl is a combination of a thiazolidinedione, Rosiglitazone, and a sulfonylurea called Glimepiride. It has the same mechanism of action as Duetact and similar side effects.
Avandomet and Acto Plus Met
These two diabetes combination medications combine a thiazolidinedione with metformin. In the case of Avandamet, rosiglitazone is combined with metformin, and with Acto Plus Met, pioglitazone is paired with metformin. This combo increases insulin sensitivity and reduces production of glucose by the liver. It causes better lowering of blood sugars than either medication used alone, but it can’t be used in people with kidney disease, liver disease or in the elderly. These two medication combinations can cause weight gain, muscle aches, fluid retention, stomach upset and increase the risk of vitamin B12 deficiency. Avandomet isn't commonly used these days, because studies show it may increase the risk of heart attacks.
This medication is a combination of metformin and sitagliptin. Sitagliptin falls into a newer class of diabetes medications called DPP-4 inhbitors. They indirectly increase the release of insulin by preventing the breakdown of a hormone that stimulates the pancreas to produce insulin. They also block the release of glucagon, a hormone that raises blood sugar levels. As already discussed, metformin increases insulin sensitivity. The combination is very effective for controlling blood sugars, but side effects can include stomach upset, headache and nasal congestion. It shouldn’t be used in anyone with kidney disease, severe liver disease or the elderly.
Diabetes Medication Combinations: The Bottom Line?
These diabetes medication combinations may control blood sugars better than a single medication and they combine two medications into a single pill, which is more convenient. This is good news for people who don’t like to take too many pills. Ask your doctor whether one of these medications is right for you.
Diabetes Essentials. Fourth Edition. 2009.
Physician’s Desk Reference. 2010.