Metformin vs Glyburide for Diabetes

Abstract

In this experimental paper, the aim is to review the therapeutic safety and efficacy of Metformin Medication and Glyburide for different types of diabetes such as gestational diabetes, non-insulin dependent diabetes, and insulin-dependent diabetes. In this paper, I reviewed five articles on the difference and similarities in the use of metformin and glyburide in the management of diabetes. The articles reviewed include Review of metformin and glyburide in the management of gestational diabetes, Systematic Review: Comparative Effectiveness and Safety of Oral Medications for Type 2 Diabetes Mellitus, Therapeutic Comparison of Metformin and Sulfonylurea, Alone and in Various Combinations: A double-blind controlled study, Glyburide Versus Metformin and Their Combination for the Treatment of Gestational Diabetes Mellitus: A Randomized Controlled Study and Treating the mother – protecting the unborn: The safety of hypoglycemic drugs in pregnancy.

Introduction

Metformin is the first line medication for treatment and management of diabetes and more specifically type 2 diabetes (Inzucchi, 2015). This type of medication is usually taken orally and is used in most cases among patients who are overweight. in most cases, it is advised that metformin should be used in combination with diet and exercise and will be able to control high blood sugar (Inzucchi, 2015). Metformin acts to help the body to respond better to the insulin that is produced by the body. Additionally, it helps to reduce the amount of sugar present in the liver and the one absorbed by the stomach (Maruthur, 2016). The most likely contradiction of metformin is that it can cause hypoglycemia or gain weight. Therefore this drug should be taken in combination with insulin to reduce the likelihood of the side effects (Forslund, 2015).

On the other hand, Glyburide is used in the treatment of diabetes. In many cases, it is used in combination with diet and exercise (Maruthur, 2016). This medication lowers the blood sugar of the body and increases the production of insulin in the body. Glyburide in classified as sulfonylureas (Maruthur, 2016). Insulin is a hormone that is produced by the pancreases that help in the breakdown of sugars in the body. However, Glyburide has not used in the treatment of type one diabetes (Landi, 2015). This is because in type 1 diabetes the body has no ability to produce insulin. It is advised that the tablet should be taken with breakfast or with the first meal of the day. However, in some cases, the doctor may advise taking twice a day.

Method

Study 1 

In a review of the management of gestational diabetes using metformin or glyburide, medication is evaluated. Globally gestational diabetes affects approximately 15% of all pregnant women (Carroll, 2014). The main aim of the review was to measure the efficacy and safety of the oral medication in the treatment of gestational diabetes. The method used in this review was online search on Google scholar using the search for gestational diabetes. Additionally randomized control trials and prospective and retrospective studies (Carroll, 2014).

Study 2 

In a systematic review to compare the safety and efficacy of oral type 2 diabetes medications to be able to determine the most appropriate therapy (Bolen, 2007). The purpose of this review was to determine the efficiency and efficacy of the oral medication of type 2 diabetes. The data was obtained from Medline and Cochrane Centara registration for controlled trials between the year 2005 November and Jan 2016 (Bolen, 2007).

Study 3 

In another review, it attempts to compare the therapeutic functions of metformin and glyburide when used alone and when used in combination with other therapeutic mechanisms (Hermann, 1994). The objective of this study was to compare the safety and efficacy of metformin and glyburide in terms of the therapeutic strengths when used alone and in combination among patients with noninsulin dependent diabetes mellitus. The method used in this study includes randomizing double-blind, case-control studies and the primary combination studies (Hermann, 1994).

Study 4 

In another review that tries to determine the efficacy of metformin and glyburide and when used in combination in the management of gestational diabetes mellitus. The method of research used in this review was a prospective randomized control study (Nachum, 2017). The study included putting 53 patients on glyburide and another 51 on metformin (Nachum, 2017).

Study 5 

In a review that aims at treating gestational diabetes mellitus and at the same time protecting the unborn with the aim of reviewing the safety of metformin and glyburide in pregnancy. This review used a randomized control trial as a research method (Klieger, 2008).

Results

Study 1 

The results from the review noted that when using glyburide as compared with insulin there were differences in the delivery patterns, modes of delivery and large gestational age were witnessed in this case (Carroll, 2014). On the other hand, when using glyburide in the management of gestational diabetes there were high numbers of high neonatal ICUs admission, hypoglycemia, and respiratory issues among infants. On the other hand when comparing metformin and insulin in gestational diabetes management no difference worth noting was seen in birth weight, the age of gestation, mode of delivery and prenatal death (Carroll, 2014).

Study 2 

Form this review it was noted that metformin has the ability to control glycemic levels. Additionally, it is noted that metformin does not lead to an increase in weight as compared to glyburide which can increase the weight by 1 to 5 kgs (Bolen, 2007). Additionally, Glyburide is in most cases associated with the risk of hypoglycemia and metformin is largely associated with gastrointestinal issues. as a conclusion, both metformin has a high ability to control blood sugar in the body (Bolen, 2007).

Study 3 

The results of this study include the fact that there was improved glucose control in cases of high dose combination. When patients were put on glyburide alone 36% showed insufficient control of blood levels (Hermann, 1994). When used in combination a good number of patients showed an increase in blood glucose after the drug was disconnected. When glyburide was used in combination with other drugs fasting c-peptide was unchanged but the fasting insulin level showed no significant change (Hermann, 1994). Furthermore, it was noted that there was no weight change witnessed when metformin is used in combination with other drugs including glyburide. Additionally, there was no increase or rise in blood pressure under the same circumstances. In conclusion, this report points to the fact that both metformin and glyburide have same chances of controlling blood glucose (Hermann, 1994). However, metformin has the capacity to regulate the blood glucose without necessarily leading to an increase in weight. on the bright side is that when glyburide and metformin are combined they have shown to have the capacity to low the blood sugar to near normal even in cases of noninsulin dependent diabetes mellitus (Hermann, 1994)..

Study 4 

The results showed that among the group on glyburide 18 of them reported drug failure, 12 lack of control of blood sugars and 6 reported hypoglycemia adverse effects. Among those on metformin 15 reported drug failure, 1 reported adverse effects and 14 reported lack of control of blood sugar (Nachum, 2017). When the treatment was combined with insulin therapy treatment success was high in metformin as compared to glyburide. In conclusion, this review states that there is less need for insulin therapy when using metformin as compared to the use of glyburide as the first line of treatment (Nachum, 2017).

Study 5 

From this review, it was determined that there is the risk of insulin transfer through the placenta to the fetus (Klieger, 2008). Therefore the review recommended that the use of metformin in the management of gestational diabetes was better as compared to the use of glyburide. This is due to that fact that when using glyburide in the management of diabetes combination with insulin id inevitable (Klieger, 2008).

References 

Bolen, S., Feldman, L., Vassy, J., Wilson, L., Yeh, H. C., Marinopoulos, S., ... & Brancati, F. L. (2007). Systematic review: comparative effectiveness and safety of oral medications for type 2 diabetes mellitus. Annals of internal medicine , 147 (6), 386-399.

Carroll, D. G., & Kelley., K. W. (2014). Review of metformin and glyburide in the management of gestational diabetes. Pharmacy Practice , 12 (4), 528.

Forslund, K., Hildebrand, F., Nielsen, T., Falony, G., Le Chatelier, E., Sunagawa, S., ... & Arumugam, M. (2015). Disentangling type 2 diabetes and metformin treatment signatures in the human gut microbiota. Nature , 528 (7581), 262.

Hermann, L. S., Scherstén, B., Bitzén, P. O., Kjellström, T., Lindgärde, F., & Melander, A. (1994). Therapeutic comparison of metformin and sulfonylurea, alone and in various combinations: a double-blind controlled study. Diabetes care , 17 (10), 1100-1109.

Inzucchi, S. E., Bergenstal, R. M., Buse, J. B., Diamant, M., Ferrannini, E., Nauck, M., ... & Matthews, D. R. (2015). Management of hyperglycemia in type 2 diabetes, 2015: a patient-centered approach: update to a position statement of the American Diabetes Association and the European Association for the Study of Diabetes. Diabetes care , 38 (1), 140-149.

Klieger, C., Pollex, E., & Koren, G. (2008). Treating the mother–protecting the unborn: the safety of hypoglycemic drugs in pregnancy. The Journal of Maternal-Fetal & Neonatal Medicine , 21 (3), 191-196.

Landi, S. N., Castillo, W. C., Boggess, K., Conover, M. M., & Funk, M. J. (2015). differential Postpartum Surveillance for Type 2 Diabetes in Women Treated with Glyburide versus Insulin for Gestational Diabetes: 604. Pharmacoepidemiology and Drug Safety , 24 , 345-346.

Maruthur, N. M., Tseng, E., Hutfless, S., Wilson, L. M., Suarez-Cuervo, C., Berger, Z., ... & Bolen, S. (2016). Diabetes medications as monotherapy or metformin-based combination therapy for type 2 diabetes: a systematic review and meta-analysis. Annals of internal medicine , 164 (11), 740-751.

Maruthur, N. M., Tseng, E., Hutfless, S., Wilson, L. M., Suarez-Cuervo, C., Berger, Z., ... & Bolen, S. (2016). Diabetes medications as monotherapy or metformin-based combination therapy for type 2 diabetes: a systematic review and meta-analysis. Annals of internal medicine , 164 (11), 740-751.

Nachum, Z., Zafran, N., Salim, R., Hissin, N., Hasanein, J., Letova, Y. G. Z., ... & Yefet, E. (2017). Glyburide versus metformin and their combination for the treatment of gestational diabetes mellitus: a randomized controlled study. Diabetes Care , dc162307.