What to do next when metformin does not work in diabetes Type2? add SU
Monotherapy with metformin is widely accepted as the second step in type 2 diabetes treatment after the failure to achieve glycemic goals with therapeutic education and lifestyle modification, including correction of diet and physical exercise habits. However, most of patients need combination therapy in first three to four years after metformin initiation. Obviously the efficacy of antidiabetic drugs used as add-on to metformin monotherapy could be different from those observed in monotherapy. In most of short-term comparative studies sulphonylureas showed greater reduction of HbA1c than other oral antidiabetics, and had a similar efficacy as insulin. However, the sustainability of this combination is limited to first two to three years and depends from the baseline HbA1c value. Concern about the cardiovascular safety of metformin and sulphonylurea combination is still under debate, but several large outcome studies didnt show increased risk of this therapy. In conclusion, metformin and sulphonylureas are unable to prevent the long-term progression of hyperglycemia in most of type 2 diabetes patients. The tailoring of treatment to the individual patient remains the most important key to successful diabetes therapy.