Can Januvia (sitagliptin) and glipizide be used together to treat diabetes?

From the Guidelines

Yes, Januvia (sitagliptin) and glipizide can be used together to treat type 2 diabetes, as this combination is often prescribed when a single medication doesn't provide adequate blood glucose control. This combination therapy is effective because Januvia works by increasing incretin hormones that stimulate insulin release and reduce glucagon secretion, while glipizide is a sulfonylurea that directly stimulates insulin release from the pancreas. The complementary mechanisms make them effective partners in diabetes management.

Key Considerations

• Typical dosing includes Januvia 100 mg once daily and glipizide 5-20 mg daily (often divided into two doses) 1.
• When starting this combination, healthcare providers usually monitor for hypoglycemia (low blood sugar), as the risk increases when using multiple glucose-lowering medications.
• Patients should be aware of hypoglycemia symptoms like shakiness, sweating, confusion, and weakness, and should have a quick source of glucose available.
• Regular blood glucose monitoring is essential when using this combination to ensure proper dosing and effectiveness.
• Kidney function should also be assessed periodically, as Januvia dosing may need adjustment in patients with reduced kidney function, with a maximum dose of 50 mg daily for patients with an eGFR of 30-44 mL/min/1.73 m2 and 25 mg once daily for those with an eGFR of 15-29 mL/min/1.73 m2 1.

Clinical Guidelines

• The American Diabetes Association recommends considering the addition of a second agent when monotherapy with a noninsulin agent at the maximum tolerated dose does not achieve or maintain the HbA1c target over 3 months 1.
• The choice of medication added to metformin is based on the clinical characteristics of the patient and their preferences, including the presence of established ASCVD or indicators of high ASCVD risk, other comorbidities, and risk for specific adverse drug effects, as well as safety, tolerability, and cost 1.

From the Research

Combination Therapy with Januvia and Glipizide

• Januvia (sitagliptin) and glipizide can be used together to treat diabetes, as evidenced by several studies 2, 3, 4, 5.
• The combination of sitagliptin and glipizide has been shown to be effective in improving glycemic control in patients with type 2 diabetes 3, 4, 5.
• Sitagliptin has been found to have a similar glucose-lowering effect to glipizide, but with the advantage of no weight gain and no hypoglycemic episodes 2.
• The use of sitagliptin in combination with glipizide has been shown to reduce the incidence of symptomatic hypoglycemia and weight gain compared to glipizide alone 3.

Efficacy and Safety

• Studies have demonstrated that the combination of sitagliptin and glipizide is effective and safe in patients with type 2 diabetes 3, 4, 5.
• The incidence of gastrointestinal adverse events was low with both treatments 3.
• Sitagliptin has been found to be generally well-tolerated, with a lower risk of hypoglycemia and weight loss versus weight gain, relative to glipizide 3.

Clinical Applications

• The combination of sitagliptin and glipizide may be a useful treatment option for patients with type 2 diabetes who are not adequately controlled on metformin or other therapies 4, 5.
• The use of sitagliptin in combination with glipizide may also be beneficial in patients with chronic renal insufficiency, as it has been shown to be effective and safe in this population 3.