Can a patient with type 2 diabetes use Ozempic (semaglutide) in combination with glyburide and metformin?

From the Guidelines

Yes, a patient with type 2 diabetes can use Ozempic (semaglutide) in combination with glyburide and metformin, as this triple therapy approach is medically acceptable. This combination leverages three different mechanisms to control blood glucose: Ozempic stimulates insulin release in response to high blood sugar and slows gastric emptying, glyburide stimulates insulin secretion from the pancreas, and metformin reduces glucose production by the liver and improves insulin sensitivity. When starting this combination, patients should be monitored closely for hypoglycemia, as both Ozempic and glyburide can lower blood sugar significantly 1. The typical starting dose for Ozempic is 0.25 mg once weekly for four weeks, then increasing to 0.5 mg weekly, while continuing the established doses of glyburide and metformin. Patients should check blood glucose levels regularly, especially when first combining these medications, and should be aware of hypoglycemia symptoms such as shakiness, sweating, confusion, and dizziness. This combination may also cause gastrointestinal side effects like nausea or diarrhea, which often improve over time 1. Staying well-hydrated and maintaining consistent meal timing can help manage these potential side effects. It is essential to consider the patient's clinical characteristics, preferences, and potential adverse effects when selecting medications to add to metformin, as recommended by the American Diabetes Association 1. The choice of medication added to metformin should be based on the patient's specific needs and characteristics, such as the presence of established ASCVD or indicators of high ASCVD risk, other comorbidities, and risk for specific adverse drug effects 1.

Some key points to consider when using this combination include:

• Monitoring for hypoglycemia and adjusting the dose of glyburide as needed
• Regularly checking blood glucose levels to adjust the dose of Ozempic and metformin
• Being aware of the potential for gastrointestinal side effects and taking steps to manage them
• Considering the patient's clinical characteristics and preferences when selecting medications to add to metformin
• Regularly reviewing and adjusting the treatment plan as needed to achieve optimal glycemic control and minimize adverse effects.

From the FDA Drug Label

OZEMPIC has been studied as monotherapy and in combination with metformin, metformin and sulfonylureas, metformin and/or thiazolidinedione, and basal insulin in patients with type 2 diabetes mellitus. In a 56-week, open-label trial (NCT01885208), 813 patients with type 2 diabetes mellitus on metformin alone (49%), metformin with sulfonylurea (45%), or other (6%) were randomized to OZEMPIC1 mg once weekly or exenatide 2 mg once weekly

Combination Therapy with Glyburide and Metformin:

• The FDA drug label states that Ozempic (semaglutide) has been studied in combination with metformin and sulfonylureas.
• Key Point: Glyburide is a sulfonylurea, and the label mentions that Ozempic can be used in combination with metformin and sulfonylureas.
• Therefore, a patient with type 2 diabetes can use Ozempic in combination with glyburide and metformin 2.

From the Research

Combination Therapy for Type 2 Diabetes

The use of Ozempic (semaglutide) in combination with glyburide and metformin for patients with type 2 diabetes is a topic of interest.

• Semaglutide is a glucagon-like peptide-1 (GLP-1) receptor agonist that has been shown to be effective in reducing HbA1c levels and body weight in patients with type 2 diabetes 3, 4, 5.
• GLP-1 receptor agonists, including semaglutide, can be used in combination with other glucose-lowering agents, such as metformin and sulfonylureas, to achieve better glycemic control 3, 4.
• The SUSTAIN FORTE trial demonstrated the efficacy and safety of once-weekly semaglutide 2.0 mg versus 1.0 mg in patients with type 2 diabetes on a stable dose of metformin with or without a sulfonylurea 4.
• Semaglutide has been shown to have cardiovascular benefits and can be used in patients with established cardiovascular disease 5.

Safety and Efficacy

• The combination of semaglutide with metformin and glyburide may be effective in achieving better glycemic control, but the safety and efficacy of this combination should be carefully evaluated 3, 4.
• Gastrointestinal disorders are the most commonly reported adverse events associated with semaglutide, but the overall safety profile is acceptable 4, 5.
• The use of semaglutide in combination with other glucose-lowering agents may increase the risk of hypoglycemia, but this risk can be mitigated with careful dose adjustment and monitoring 3, 4.

Clinical Considerations

• The choice of glucose-lowering therapy should be individualized based on patient characteristics, comorbidities, and treatment goals 3, 5.
• Semaglutide may be a useful addition to the treatment regimen for patients with type 2 diabetes who are not achieving adequate glycemic control with metformin and glyburide alone 4, 5.
• Further studies are needed to fully evaluate the safety and efficacy of semaglutide in combination with glyburide and metformin 3, 4.