From the Guidelines
Sulfonylureas are a suitable alternative when Metformin does not control blood sugar levels, as they can be given to patients with type 2 diabetes who do not achieve glycemic control with metformin alone or who have contraindications to metformin 1.
Key Considerations
- A sulfonylurea can be prescribed as an alternative, with a strong recommendation and moderate-quality evidence 1.
- Other options, such as dipeptidyl peptidase-4 (DPP-4) inhibitors, sodium–glucose cotransporter-2 (SGLT-2) inhibitors, or thiazolidinediones (TZDs), may be considered if insulin is unsuitable, although the recommendation is weak and based on very-low-quality evidence 1.
- It is crucial to monitor blood sugar levels, kidney function, and other parameters to adjust the treatment plan accordingly.
- Consultation with a healthcare provider is necessary to determine the best course of treatment, considering the individual patient's needs and medical history.
Medication Options
- Sulfonylureas, such as glipizide, can be started with a dose of 5 mg daily and titrated up to a maximum of 20 mg daily as needed.
- DPP-4 inhibitors, such as sitagliptin, can be started with a dose of 100 mg daily.
- SGLT2 inhibitors, such as canagliflozin, can be started with a dose of 100 mg daily.
From the FDA Drug Label
Glipizide is an oral blood-glucose-lowering drug of the sulfonylurea class. The FDA drug label supports the use of glipizide as an oral medication to lower blood sugar levels.
- Key points:
- Glipizide is an oral blood-glucose-lowering drug.
- It belongs to the sulfonylurea class. When Metformin does not control blood sugar levels, glipizide can be used as an alternative oral medication 2.
From the Research
Alternative Oral Medications to Metformin
When metformin does not control blood sugar levels, several alternative oral medications can be considered. These include:
- Sodium-glucose co-transporter-2 (SGLT-2) inhibitors, such as ertugliflozin and canagliflozin 3
- Dipeptidyl peptidase-4 (DPP-4) inhibitors, such as sitagliptin 3
- Glucagon-like peptide-1 (GLP-1) receptor agonists 3, 4
- Sulfonylureas, which can be used in combination with incretins (GLP-1 receptor agonists or DPP-4 inhibitors) 5
- Thiazolidinediones, which can be used in combination with incretins (GLP-1 receptor agonists or DPP-4 inhibitors) 5
Combination Therapies
Combination therapies can also be effective when metformin is not an option. These include:
- Dual add-on oral antihyperglycemic agents, such as ertugliflozin + sitagliptin, which have been shown to have a greater reduction in HbA1c compared to single agents 3
- Combinations of incretins (GLP-1 receptor agonists or DPP-4 inhibitors) with a sulfonylurea, thiazolidinedione, or insulin 5
- Combinations of an oral sodium-glucose cotransporter 2 inhibitor and a DPP-4 inhibitor, which have been shown to reduce glycated hemoglobin (A1C) and weight with no additive risk of hypoglycemia 5
Considerations for Selecting Alternative Therapies
When selecting alternative therapies to metformin, it is essential to consider the individual patient's needs and balance clinical benefits with potential risks, such as weight gain and hypoglycemia 5. Treatment approaches should be individualized for vulnerable patient populations for whom metformin is not appropriate 5.