Combination pills for type 2 diabetes   (July 19, 2008)

[Editor's note: Please also see Update on combination pills for people with diabetes, February 2012.]

There are six classes of diabetes pills (also called "oral hypoglycemic agents"). Many of them can be combined (previously only by your physician's recommendation, but more recently also by manufacturers) to get extra effect to control blood sugar levels.

Since these diabetes combination pills are only available by brand name, and since generic versions of their ingredients are usually available, the combination pills are more expensive. And using fixed-combination pills offer less flexibility: if the dose of one ingredient needs to be adjusted, both would end up being adjusted.

But the benefits of an easier routine may make the added cost worthwhile, if the combination is able to control your diabetes. For example, there may be less pills to swallow, and for people who have insurance for their medications, it's only a single copayment for the combination product.

The six classes of diabetes pills are:

1. sulfonylureas - glyburide (DiaBeta, Micronase), glipizide (Glucotrol, Glucotrol XR) glimeprimide (Amaryl), and many others.

2. biguanides - metformin (Glucophage)

3. thiazolidinediones - (pioglitazone (Actos) and rosiglitazone (Avandia)

4. meglitinides - repaglinide (Prandin) and nateglinide (Starlix)

5. alpha-glucosidase inhibitors acarbose (Precose) and miglitol (Glyset)

6. DPP-4 inhibitors - sitagliptin (Januvia)

The presently available combination pills for diabetes are:

* Combination of glyburide plus metformin: Brand name: GlucoVance (Bristol-Myers Squibb) (Approved by FDA July 31, 2000.)

* Combination of rosiglitazone plus metformin: Brand name: Avandamet (GlaxoSmithKline) (Approved by FDA October 10, 2002.)

* Combination of glipizide plus metformin: Brand name: Metaglip (Bristol-Myers Squibb) (Approved by FDA October 22, 2002.)

* Combination of metformin plus pioglitazone: Brand name: Actoplus Met (Takeda) (approved by FDA August, 2005.)

* Combination of Avandia plus Amaryl: Brand name: Avandaryl (GlaxoSmithKline) (approved by FDA November 23, 2005.)

* Combination of Januvia plus metformin: Brand name: Janumet (Merck) (approved by FDA April 2, 2007.)

* Combination of Amaryl plus Actos: Brand name: Duetact (Takeda) (approved by FDA July, 2006.)

Should you ask your physician about switching to a combination pill? Yes, if you have type 2 diabetes, are on two diabetes pills that are presently available as a combination, and your doses have been stable for at least several months. But also be sure to check the prices with your pharmacy and insurance company to see if you'll save money.