Published: 2017-02-24

Comparison of the efficacy and safety of Glimepiride and Glipizide as add-on therapy with metformin in patients of type 2 diabetes mellitus

Madhuri Chatterjee, Taruna Sharma, Anita Sharma, Juhi Kalra


Background: Type 2 diabetes mellitus (T2DM) is a chronic metabolic disorder carrying an enormous burden of morbidity and mortality because of its characteristic complications, many of which are preventable with strict glycaemic control. Initial management of T2DM consists of non-pharmacological interventions; it those fail, an oral anti-diabetic drug, most typically metformin, is started. Combination therapy is initiated only when monotherapy fails to achieve glycaemic control. Glipizide and glimepiride, a second and a third generation sulphonylurea respectively, are the commonest drugs added to metformin when the latter fails to achieve euglycaemia on its own. Aims and Objectives of the study were to compare the efficacy and safety of glimepiride and glipizide as add-on therapy to metformin in patients of uncontrolled T2DM.

Methods: This prospective, observational and analytical study was conducted by the Department of Pharmacology among patients attending the Internal Medicine OPD of a tertiary-care hospital. Fifty patients were assigned to two groups of 25 patients each: Group A - Glimepiride + Metformin and Group B - Glipizide + Metformin. Patients were followed up for three months. Data were analysed by Student's t-test.

Results: There was a significant decrease in the HbA1c, FBS and 2h-PPBS in both groups. However there was no significant difference between the two groups during the three-month period of follow-up.

Conclusions: The combination of glimepiride and metformin is just as effective and safe as the combination of glipizide and metformin in patients not controlled on monotherapy with metformin.


Metformin, Type 2 diabetes mellitus, Sulphonylureas

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American Diabetes Association. 2. Classification and diagnosis of diabetes. Diabetes care. 2015;38(1):S8-16.

Shaw JE, Sicree RA, Zimmet PZ. Global estimates of the prevalence of diabetes for 2010 and 2030. Diabetes research and clinical practice. 2010;87(1):4-14.

Nolan CJ, Damm P, Prentki M. Type 2 diabetes across generations: from pathophysiology to prevention and management. The Lancet. 2011 Jul;378(9786):169-81.

Nathan DM, Buse JB, Davidson MB, Ferrannini E, Holman RR, Sherwin R, et al. Medical management of hyperglycaemia in type 2 diabetes mellitus: a consensus algorithm for the initiation and adjustment of therapy. Diabetologia. 2009 Jan;52(1):17-30.

Joshi SR. Metformin: Old wine in new bottle-evolving technology and therapy in diabetes. JAPI. 2005 Nov;53:963-72.

Inzucchi SE, Bergenstal RM, Buse JB, Diamant M, Ferrannini E, Nauck M, et al. Management of hyperglycemia in type 2 diabetes: a patient-centered approach position statement of the American Diabetes Association (ADA) and the European Association for the Study of Diabetes (EASD). Diabetes care. 2012 Jun 1;35(6):1364-79.

Krentz AJ, Bailey CJ. Oral antidiabetic agents. Drugs. 2005 Feb;65(3):385-411.

Kabadi UM. Sulfonylurea Glimepiride: A Proven Cost Effective, Safe and Reliable War Horse in Combating Hyperglycemia in Type 2 Diabetes. Journal of Diabetes Mellitus. 2015 Sep;5(04):211.

Mohan V, Shah S, Saboo B. Current glycemic status and diabetes related complications among type 2 diabetes patients in India: data from the A1chieve study. The Journal of the Association of Physicians of India. 2013;61(1):12-5.

Duckworth W, Abraira C, Moritz T, Reda D, Emanuele N, Reaven PD, et al. Glucose control and vascular complications in veterans with type 2 diabetes. New England Journal of Medicine. 2009 Jan;360(2):129-39.

González-Ortiz M, Guerrero-Romero JF, Violante-Ortiz R, Wacher-Rodarte N, Martínez-Abundis E, Aguilar-Salinas C, et al. Efficacy of glimepiride/metformin combination versus glibenclamide/metformin in patients with uncontrolled type 2 diabetes mellitus. Journal of diabetes and its complications. 2009 Dec;23(6):376-9.

Nauck MA, Meininger G, Sheng DO, Terranella L, Stein PP. Efficacy and safety of the dipeptidyl peptidase‐4 inhibitor, sitagliptin, compared with the sulfonylurea, glipizide, in patients with type 2 diabetes inadequately controlled on metformin alone: a randomized, double‐blind, non‐inferiority trial. Diabetes, Obesity and Metabolism. 2007;9(2):194-205.

Nauck M, Frid A, Hermansen K, Shah NS, Tankova T, Mitha IH, et al. Efficacy and safety comparison of liraglutide, glimepiride, and placebo, all in combination with metformin, in type 2 diabetes the LEAD (liraglutide effect and action in diabetes)-2 study. Diabetes care. 2009 Jan;32(1):84-90.

Santos GK. The safety and efficacy of metformin and glimepiride combination among Filipinos with Type 2 Diabetes Mellitus. Available from:

Göke B, Gallwitz B, Eriksson J, Bokelundsingh S, Gause-Nilsson I. Saxagliptin vs glipizide as add-on therapy to metformin for type 2 diabetes mellitus (T2DM): long-term safety and efficacy. Diabetes. 2011 Jun;60(1):A305.

Charpentier G, Fleury F, Kabir M, Vaur L, Halimi S. Improved glycaemic control by addition of glimepiride to metformin monotherapy in type 2 diabetic patients. Diabetic Medicine. 2001 Oct;18(10):828-34.