Diabetes Dual Therapy May Help Blood Sugar Control

Diabetes patients may improve bloods sugar levels with combo of vildagliptin and metformin

/ Author:  / Reviewed by: Robert Carlson, M.D Beth Bolt, RPh

(RxWiki News) Combination therapy using two different types of diabetes medication can effectively control blood sugar. New research confirms that adding vildagliptin to metformin can be a beneficial mix.

People with diabetes can have abnormally high blood sugar levels because their bodies are either not making enough insulin or their insulin is not being used effectively. Insulin is a hormone that helps cells absorb blood sugar and use it for energy.

Two medications have been shown to control blood sugar levels in diabetes patients, and now a new study finds that adding vildagliptin to metformin can benefit patients as well.

"Ask a doctor how combination therapy may improve blood sugar levels."

Masato Odawara, MD, in internal medicine at Tokyo Medical University, and fellow scientists tracked 139 patients with type 2 diabetes who were taking metformin.

Over the course of 12 weeks, 69 of these patients were randomly assigned to receive vildagliptin, while 70 were given a placebo.

Vildagliptin (brand names Galvus, Zomelis and Jalra) works by increasing the amount of insulin and reducing the amount of glucagon secreted by the pancreas. Glucagon is a hormone like insulin, and it causes the liver to make more sugar in the body.

Vildagliptin is not approved for use in the U.S.

Metformin (brand names Glucophage, Glumetza, Glucophage XR and Fortamet) does not increase insulin production, but it stimulates insulin sensitivity by increasing the number of insulin receptors in the body and heightening the attraction for the receptors.

At three months, researchers checked hemoglobin A1c (HbA1c), which provides the average level of blood sugar (glucose) over the previous three months. In the vildagliptin group, HbA1c dropped by 1.1 percent. HbA1c only dipped by .1 percent in the placebo group.

For many with diabetes, the goal is to get HbA1c levels below 6.5 to 7 percent. Almost a third of vildagliptin patients reached HbA1c target levels of 6.5 percent or lower, while only about 3 percent reached that goal in the placebo group. About 64 percent of vildagliptin patients achieved HbA1c of under 7 percent compared to 15 percent in the placebo arm.

There were no deaths or hypoglycemic events (severe blood sugar drops) among these subjects.

“The notable benefit observed in improving HbA1c levels confirms the complementary mechanism of action of vildagliptin and metformin in Japanese patients with type 2 diabetes,” wrote the authors.

Steve Leuck, PharmD, expressed his concerns with this research study and said, "This study, however promising for the treatment of diabetes, concerns me due to the small study population of 139 patients. The positive results seen are encouraging and it would be nice to see the results of a large study (10,000+ individuals) of this combination therapy with all of the appropriate controls."

Dr. Leuck, president and owner of AudibleRx continued by stating, "In my practice, I have seen metformin prescribed as first-line therapy for many newly diagnosed Type II diabetics. Metformin alone, when combined with diabetes education, appropriate diet and physician approved exercise, has been shown to provide adequate control of blood sugar for many patients."

Other studies have already recognized the effectiveness of this dual diabetes therapy, and pharmaceutical companies are creating medications that combine the two in one form, such a Galvumet and Eucreas.

The study was published online in March in Diabetes Therapy. Masato Odawara is the independent medical advisor for this study and has received consultancy fees from Novartis Pharma K.K.

Review Date: 
March 24, 2014
Last Updated:
March 28, 2014