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Clinician’s Corner: Type-2 Diabetes COMBINATION THERAPY

We are all familiar with Metformin (Glucophage) knowing it is the first drug prescribed for our Type-2 Diabetic (T2DM) patients.  As we are all aware, rarely is this monotherapy effective unless our patient makes the necessary lifestyle modifications.  Most references show that only 7% of T2DM patients will make the necessary lifestyle/dietary modifications necessary to combat this disease that is now affecting 1 out of 10 Americans.  For the other 93% of our patients we need to look at additional pharmacotherapy to manage their Type-2 Diabetes.


Even with drug treatment Type-2 diabetics, will eventually need additional therapy to treat their hyperglycemia.

  • After 3 years, 50% of patients will need a second drug
  • After 9 years, nearly 75% will need the second drug added.
  • Most common combination therapy if cost is a concern is sulfonylurea + metformin.
  • As diabetes progresses a third drug is often added—either another oral agent, GLP-1, or insulin.
  • Addition of insulin should NOT be postponed in patients with poor glycemic control that have failed on multiple drug regimens.
  • Look at the patient, consider need for weight loss, adherence, insurance coverage, cost of medications etc.


Treatment Expected decrease in HbA1c Estimated monthly cost
Exercise, diet weight loss 1-2%  
Metformin 1.5% $8.00
Avandia/Actos 1-1.5% $12.00
Sulfonylurea (glipizide, glimepiride, eglyburide) 1.5% $8.00
Alpha glucosidase inhibitors (Precose/Glyset) 0.5-0.8% $22.00
Glinides (Starlix/Prandin) 0.5-1% $30.00
Incretins (Victoza, Trulicity, Ozempic) 1-1.5% $800.00
DPP4 inhibitors (Januvia, Tradjenta) 0.5-1% $500.00
SGLT2 inhibitors ((Invokana, Jardiance, etc) 0.5-1% $550.00
insulin -basal 1 vial 1.5-3.5% $320.00

*Consider initial therapy with insulin if HbA1c is greater than 10%, fasting glucose is over

Example:  the goal A1C you set is 7% for example.

If a patient comes in with a HbA1c =9 there is NO way he can get there by adding Januvia®!

Your Thompson Pharmacist can help you and your physician decide what treatment options are best for you.  Go Ahead and Ask, at Thompson Pharmacy It’s All for YOU!