Comparing the combination sitagliptin/metformin with glimepiride/metformin

In 2018, the Institute for Quality and Efficiency in Health Care (IQWiG, Germany) last looked into the advantages and disadvantages of sitagliptin (trade name: Januvia or Xelevia) compared with the standard treatments for type 2 diabetes in adults.

The results of two studies comparing the combination sitagliptin/metformin with glimepiride/metformin were available for analysis. The assessment was based mainly on the longer-lasting of the two studies.

What are the advantages of the combination sitagliptin/metformin?

  • Symptomatic hypoglycemia: The study suggests that symptomatic hypoglycemia was less common with sitagliptin/metformin than it was with glimepiride/metformin. About 22 out of 100 people who took glimepiride/metformin had hypoglycemia (blood sugar levels below 70 mg/dl) that also caused symptoms. In the group of people who took sitagliptin/metformin, about 3 out of 100 had this kind of hypoglycemia.

No difference

  • Life expectancy and complications: There was no difference between sitagliptin/metformin and glimepiride/metformin here. But there was little data available for this comparison.
  • Severe hypoglycemia: Severe hypoglycemia was equally uncommon in both groups. There was no difference between the two drug combinations.
  • Pancreatic inflammation, kidney dysfunction and severe side effects: There was no difference between the two drug combinations here.
  • Treatment stopped due to side effects: The analysis of the longer study showed no differences here.

What remains unanswered?

  • Quality of life: Due to a lack of conclusive data, it isn't possible to say whether there are any differences between the two treatment groups here.