A Review on Drug Related Problems in Type 2 DM with Combination of Sulfonylureas and Biguanides

Increased drug related problems in diabetic patients treated with combinations of high doses of sulfonylureas and metformin was recently reported. This review article is aimed towards the assessment of drug related problems in patients treated with low-doses of sulfonylureas and biguanides. Sulphonylureas the second most commonly used antidiabetic drugs after metformin; there have been concerns regarding the cardiovascular safety of sulfonylureas. These safety concerns initiated with the University Group Diabetes Program conducted in the 1960s, found a sulfonylurea, tolbutamide, where tolbutamide is a first-generation sulfonylurea and was associated with an increased risk of all-cause and cardiovascular problems compared with placebo. Indeed, sulfonylureas have been associated with known cardiovascular risk factors like weight gain, fluid retention, and hypoglycemia. Phenformin, a biguanide, was related to lactic acidosis and withdrawn from use after causing increased risk factors within the University Group Diabetes Program since then, a more modern biguanide, metformin, has risen to its current place because the leading oral therapy for diabetes supported its relative lack of hazard from lactic acidosis and evidence especially from a subgroup of participants in the UK Prospective Diabetes Study, that it can reduce cardiovascular risk and other drug related problems. But there are certain studies showing that combination treatment with metformin and sulfonylurea is more effective, than drugs alone in enabling glycemic control in type 2 diabetes. However, safety of such combinations deserves further investigation.