Best Second Oral Agent to Metformin to Manage Type 2 Diabetes

Diabetes is a major health concern in the United States with many long-term complications, such as heart disease, stroke, kidney failure, blindness, and amputation. According to the Center for Disease Control, as of 2020, 34.1 million of US adult had diabetes and 88 million were prediabetic. Due to the severe complications, it is important to manage diabetes with lifestyle changes and pharmacotherapies. Many oral agents such as metformin, sodium glucose transporter 2 inhibitors (SGLT2i), and sulfonylureas are used in the management of type II diabetes. Metformin is typically the first line pharmacotherapy. However, when metformin alone is not enough to adequately control hyperglycemia, combination therapy is recommended. The goal of this literature review is to investigate differences in safety and efficacy when using monotherapies (metformin, SGLT2i, sulfonylureas) and combination therapy (metformin- SGLT2i versus metformin-sulfonylureas) in management of type II diabetes. A comprehensive literature review was done using different electronic databases such as Pub-Med, Clinical Key, Cochrane Library, access medicine, CINAHL Complete and Dynamed Plus. Review of the literature showed each monotherapy reduces A1c to some extent. SGLT2i users had better cardio-protectiveness than sulfonylureas. The use of metformin-SGLT2i has significantly greater reduction in hemoglobin A1c (HbA1c), and body weight compared to metformin-sulfonylureas. However, sulfonylureas are more widely used because they are cheaper and well-studied. Studies also stated that sulfonylurea cause more hypoglycemic episodes compared to metformin or SGLT2 inhibitors