Comparative Efficacy of Metformin and Sulfonylurea in Monotherapy or Combination for Type 2 Diabetes


  • Northern Border University, Department of Pharmaceutics, Faculty of Pharmacy, Saudi Arabia
  • Northern Area Armed Forces Hospital, Department of Pharmacy, Saudi Arabia


Despite the extensive efforts of physicians to achieve better control and management for blood glucose level in type 2 diabetics, maintaining near normal blood glucose level in these patients remain unsatisfactory. The objective of the study was to compare the effectiveness of sulfonylureas, metformin and combination of metformin plus sulfonylureas in controlling blood glucose in type 2 diabetics. Retrospective cohort research design conducted during the period of two months from 1st November 2019 to 1st March 2020 at Northern Area Armed Forces Hospital in Hafr Al Batin- Saudi Arabia on sample of 217 diabetic patients’ files, all data coded with serial number and analyzed by SPSS program through and inferential and descriptive statistics. Mean decrease in HbA1c for metformin therapy was 1.5(%), for sulfonylurea was 1.4(%), for combination therapy was 1.9(%). Mean decrease in HbA1c fasting blood glucose for metformin therapy was 1.8(mmol/l), for sulfonylurea was 1.6(mmol/l), for combination therapy was 3(mmol/l). Mean decrease in postprandial blood glucose for metformin therapy was 3.2(mmol/l), for sulfonylurea therapy was 3(mmol/l), for combination therapy was 3.7(mmol/l). There was a significant difference between levels of HbA1c between metformin group and combination group (metformin and sulfonylurea) (p = 0.002) and also there was a significant difference between sulfonylurea group and combination group (metformin and sulfonylurea) in relation to HbA1c levels (p = 0.001). However, there was no significant difference between metformin and sulfonylurea in decreasing HbA1c (p = 0.09). In conclusion, metformin or sulfonylurea as a single therapy is similar in efficacy in reducing glycosylated hemoglobin level, fasting and post-prandial plasma glucose levels to equal degree. However, combination of both therapies resulted in significant greater control of blood glucose level.


Combination Type 2 Diabetes, Efficacy, Metformin, Monotherapy, Sulfonylureal

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Mendis S Global status report on noncommunicable diseases; 2014.

Al-Hazzaa HM. Prevalence of physical inactivity in Saudi Arabia: A brief review. Eastern Mediterranean Health Journal. 2004; 10:663–70.

Elhadd TA, Al-Amoudi AA, Alzahrani AS. Epidemiology, clinical and complications profile of diabetes in Saudi Arabia: A review. Annals of Saudi Medicine. 2007; 27:241–50. PMid:17684435. PMCid:PMC6074292

Al-Nozha MM, Al-Maatouq MA, Al-Mazrou YY, Al-Harthi SS, Arafah MR, Khalil MZ, et al. Diabetes mellitus in Saudi Arabia. Saudi Medical Journal. 2004; 25:1603–10.

Swinburn B. Sustaining dietary changes for preventing obesity and diabetes: Lessons learned from the successes of other epidemic control programs. Asia Pacific Clinical Nutrition Society. 2002; 11(Suppl 3):S598–606. PMid:12492653

Hussain A, Claussen B, Ramachandran A, Williams R. Prevention of type 2 diabetes: A review. Diabetes Research and Clinical Practice. 2007; 76:317–26. PMid:17069920

DeFronzo RA. Pharmacologic therapy for type 2 diabetes mellitus. Annals of Internal Medicine. 1999; 131:281–303. PMid:10454950

Wolfs M, Hofer MH, Wijmenga C, van Haeften TW. Type 2 diabetes mellitus: New genetic insights will lead to new therapeutics. Current Genomics. 2009; 10:110–18. PMid:19794883. PMCid:PMC2699827

Power A, Fauci A, Kasper D, et al. Diabetes mellitus. Harrison’s principle of medicine.16th edit. 2007; 14(323):2152–8.

Feinglos MN, Bethel MA. Treatment of type 2 diabetes mellitus. Medical Clinics of North America. 1998; 82:757– 90.

American Diabetes Association. The pharmacological treatment of hyperglycemia in NIDDM. Diabetes Care. 1995; 18:1510–8. PMid:8722084

Alwakeel JS, Al-Suwaida A, Isnani AC, Al-Harbi A, Alam A. Concomitant macro and micro-vascular complications in Diabetic nephropathy. Saudi Journal of Kidney Diseases and Transplantation. 2009; 20:402–9.

Tabish, SA. Is diabetes becoming the biggest epidemic of the twenty-first century? International Journal of Health Sciences. 2007; 1(2):V–VIII.

The Ministry of Health. Statistics Report; 2015.

Kearns K, Dee A, Fitzgerald AP, Doherty E, Perry IJ. Chronic disease burden associated with overweight and obesity in Ireland: The effects of a small BMI reduction at population level. BMC Public Health. 2014; 14. PMid:24512151. PMCid:PMC3929131

Al-Rubeaan K. National surveillance for type 1, type 2 diabetes and prediabetes among children and adolescents: A population-based study (SAUDI-DM). Journal of Epidemiology and Community Health. 2015; 69(11):1045–51. PMid:26085648. PMCid:PMC4680138

Al-Nozha, Mansour M, et al. Diabetes mellitus in Saudi Arabia. Saudi Medical Journal. 2004; 25,11:1603–10.

Al-Rubeaan, K, Alâ€Manaa HA, Khoja TA, Ahmad NA, Al†Sharqawi AH, Siddiqui K, et al. Epidemiology of abnormal glucose metabolism in a country facing its epidemic: SAUDI-DM study. Journal of Diabetes. 2015; 7(5):622–32. PMid:25266306

Al-Daghri NM, Al-Attas OS, Alokail MS, Alkharfy KM, Yousef M, Sabico SL, et al. Diabetes mellitus type 2 and other chronic non-communicable diseases in the central region, Saudi Arabia (Riyadh cohort 2): A decade of an epidemic. BMC Medicine. 2011 Jun; 9(76). PMid:21689399 PMCid:PMC3141541

Alqurashi, Khalid A et al. Prevalence of diabetes mellitus in a Saudi community. Annals of Saudi Medicine. 2011; 31(1):19– 23. PMid:21245594.


Al-Baghli, NA, Al-Ghamdi AJ, Al-Turki KA, Al Elq AH, El-Zubaier AG, Bahnassy A. Prevalence of diabetes mellitus and impaired fasting glucose levels in the Eastern Province of Saudi Arabia: Results of a screening campaign. Singapore Medical Journal. 2010; 51(12):923–30.

Tosi F, Muggeo M, Brun E, Spiazzi G, Perobelli L, Zanolin E, et al. Combination treatment with metformin andvglibenclamide versus single-drug therapies in type 2 diabetes mellitus: A randomized, double-blind, comparative study. Metabolism. 2003; 52(7):862–7.

Inzucchi SE, Bergenstal RM, Buse JB, Diamant M, Ferrannini E, Nauck M, et al. Management of hyperglycaemia in type 2 diabetes: A patient-centered approach. Position statement of the American Diabetes Association (ADA) and the European Association for the Study of Diabetes (EASD) Diabetologia. 2012; 55:1577–96. PMid:22526604

Bennett WL, Maruthur NM, Singh S, Segal JB, Wilson LM, Chatterjee R, et al. Comparative effectiveness and safety of medications for type 2 diabetes: An update including new drugs and 2-drug combinations. Annals of Internal Medicine. 2011; 154:602–13. PMid:21403054. PMCid:PMC3733115

American Diabetes Association. Standards of medical care in diabetes 2009. Diabetes Care. 2009; 32(1):15. https://doi. org/10.2337/dc09-S013. PMid:19118286. PMCid:PMC2613589

Stephenne X, Foretz M, Taleux N, et al. Metformin activates AMP activated protein kinase in primary human hepatocytes by decreasing cellular energy status. Diabetologia. 2011; 54:3101–10. s00125-011-2311-5. PMid:21947382. PMCid:PMC3210354

Triplitt C, Reasner C. Chapter 83: diabetes mellitus. In DiPiro JT, Talbert RL, Yee GC, Matzke GR, Wells BG, Posey LM. Pharmacotherapy: A pathophysiologic approach (8th ed.). New York, NY: McGraw-Hill. 2011; 27:1274.

Draeger KE, Wernicke-Panten K, Lomp HJ, Schuler E, Rosskamp R. Long-term treatment of Type 2 diabetic patients with the new oral antidiabetic agent glimepiride (Amaryl): A double-blind comparison with glibenclamide. Hormone and Metabolic Research. 1996 Sep; 28:419–25. PMid:8911976

Eisenberg Center at Oregon Health & Science University. Comparing oral medications for adults with Type 2 diabetes: Clinician’s Guide [Internet]. 2007 Dec 5. In: Comparative Effectiveness Review Summary Guides for Clinicians. Rockville (MD): Agency for Healthcare Research and Quality (US). 2007. Available from:

Bolen S, Feldman L, Vassy J, Wilson L, Yeh HC, Marinopoulos S, et al. Systematic review: Comparative effectiveness and safety of oral medications for type 2 diabetes mellitus. Annals of Internal Medicine. 2007; 147. PMid:17638715

Inzucchi SE. Oral antihyperglycemic therapy for type 2 diabetes scientific review. Journal of the American Medical Association. 2002; 287. PMid:11790216

Blonde L, San Juan ZT. Fixed-dose combinations for treatment of type 2 diabetes mellitus. Advances in Therapy. 2012; 29. PMid:22271157

Cheong C, Barner JC, Lawson KA, Johnsrud MT. Patient adherence and reimbursement amount for antidiabetic fixed dose combination products compared with dual therapy among Texas Medicaid recipients. Clinical Therapeutics. 2008; 30. PMid:19014846

Blonde L, San Juan ZT, Bolton P. Fixed-dose combination therapy in type2 diabetes mellitus. Endocrine Practice. 2014; 20. PMid:25370323


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