In the field of drug treatment for type 2 diabetes , metformin has been used clinically for decades, but it is still a basic medication and a classic drug. It has been listed as a type 2 diabetes patient in major diabetes medication guides for many years. initial medication selection. However, with the launch of some new antidiabetic drugs, the clinical status of metformin has gradually begun to change.
In the newly released guidelines for the management of hyperglycemia in type 2 diabetes in 2022 by the American Diabetes Association, regarding the selection of drug treatment paths for type 2 diabetes, it is pointed out that people at high risk of cardiovascular disease or kidney disease should choose drug treatment. Priority should be given to SGLT2 inhibitor drugs and GLP-1 receptor agonist drugs. SGLT2 inhibitors representative drugs include dapagliflozin , empagliflozin , canagliflozin, etc.; while GLP-1 receptor agonist drugs include liraglutide , dulaglutide , sigemellutide and many other drugs.
GLP-1 receptor agonist drugs are administered by subcutaneous injection. They have good hypoglycemic effects and strong weight loss effects. However, the disadvantage is that they are expensive, so we will not discuss them here. Compared with SGLT2 inhibitors such as metformin and dapagliflozin, which are also taken orally, should patients with type 2 diabetes really choose dapagliflozin instead of metformin? Today’s popular science article will talk to you about blood sugar lowering and medication selection for patients with diabetes and .
Diabetic patients have different treatment goals and different medication choices.
When it comes to medication for diabetic patients, the first thing that should be considered is not which medicine to take, but rather what our long-term goal of controlling diabetes is. To clarify the goals, it is necessary to assess the health risks of diabetic patients. In the aforementioned high blood vessel management guidelines, diabetic patients are divided into two different situations, and their treatment goals and drug selections are also different.
The first category is those with type 2 diabetes who do not have heart and kidney risks. The treatment goals for this group of people should mainly be to strictly control blood sugar and maintain a healthy weight. Achieving this goal can greatly reduce the risk of diabetes complications .
For this type of patients, while maintaining good diet control and exercise, in terms of drug selection, metformin has a clear hypoglycemic effect and high drug safety, and can still be used as the preferred drug to control blood sugar. On the basis of using metformin, if blood sugar is still not up to standard, you can consider combining it with other anti-diabetic drugs, such as dapagliflozin, to further enhance the anti-diabetic effect.
The second category refers to people with type 2 diabetes and high-risk heart and kidney risks. This group of people is actually more common. For example, if you are over 45 years old and have type 2 diabetes, and if your low-density lipoprotein cholesterol exceeds 2.6mmol/L, you are a high-risk group for cardiovascular disease; and if you have type 2 diabetes, start People with microalbuminuria and are at risk for kidney disease, and those with existing cardiovascular disease and chronic renal impairment certainly also fall into this category.
For such patients, the goal should be to reduce the risk of cardiorenal adverse events. Of course, lowering blood sugar is an important aspect of controlling cardiorenal risks, but while lowering blood sugar, if you can choose antidiabetic drugs with additional cardiorenal benefits, such as SGLT2 inhibitors such as dapagliflozin, they are more effective than metformin. Therefore, for such patients, regardless of whether metformin is included in the medication regimen, priority should be given to using SGLT2 inhibitors or GLP-1 receptor agonists to strengthen blood sugar control and reduce risks to heart and kidney health.
Therefore, from the perspective of drug selection, different groups of people have different treatment goals, and the choice of anti-diabetic drugs will also be different. It cannot be said in general that metformin has been replaced by dapagliflozin.
Metformin and dapagliflozin each have their own advantages and disadvantages.
Now that we understand the medication options for patients with type 2 diabetes with different treatment goals, let’s compare the advantages and disadvantages of metformin and SGLT2 inhibitors (taking dapagliflozin as an example).
In terms of its mechanism of action, metformin mainly reduces blood sugar by inhibiting hepatic glycogen output, inhibiting intestinal absorption of sugar, and improving the utilization of glucose by peripheral cells, while dapagliflozin mainly reduces blood sugar through Regulates the kidney's renal glucose threshold , increases urinary glucose excretion to lower blood sugar levels. From the perspective of hypoglycemic effect, both drugs can effectively reduce fasting blood sugar and postprandial blood sugar. The intensity of blood sugar reduction is basically similar. On average, they can reduce the glycosylated hemoglobin level of diabetic patients by more than 1%.
Metformin has the advantage of wide application range and high economical medication. For patients with type 2 diabetes, metformin is a classic medication that can be used when diabetes is discovered and drug treatment is needed. It can also be retained in the medication regimen of diabetic patients as long as there are no contraindications. In terms of scope of application, metformin has a wide range of applications. Except for patients with severe liver and kidney dysfunction, metformin has relatively few contraindications. In terms of medication economics, both regular metformin tablets and extended-release tablets have been included in the centralized purchasing catalog. The originally inexpensive medication price has further declined. For patients taking regular tablets, the monthly medication cost is only a few yuan. , the accessibility and economy of the drug are unmatched by other hypoglycemic drugs .
Compared with metformin, dapagliflozin has two advantages. First, in terms of weight loss, although metformin has a certain weight loss effect, this effect is relatively weak. Dapagliflozin, a drug that improves blood sugar levels by promoting urinary glucose excretion, can promote glucose excretion in the body. The weight-lowering effect is also stronger than that of metformin. Long-term use of dapagliflozin can make diabetic patients lose about 3 to 5 kg of weight. It is an additional health benefit for obese diabetic patients to control their weight.
On the other hand, dapagliflozin is better than metformin in terms of cardio-renal protection. Metformin can reduce the risk of cardiovascular disease, but this effect mainly comes from the clear hypoglycemic effect of the drug, while dapagliflozin In addition to lowering blood sugar, it also has many health benefits such as improving proteinuria, regulating and lowering blood pressure, and assisting in reducing uric acid . This multi-faceted regulatory effect gives it a stronger cardio-renal protective effect. At present, drugs such as dapagliflozin are not only used to control blood sugar in patients with type 2 diabetes, but can also be used to treat patients with chronic kidney disease and heart failure patients. This cardio-renal protective effect depends on its indications. Gradual expansion is also evident.
In terms of medication safety, although metformin and dapagliflozin each have different risks of adverse reactions, generally speaking, the safety of metformin is better than that of dapagliflozin. The most common adverse reactions of metformin are gastrointestinal adverse reactions, such as nausea, gastrointestinal discomfort, etc. However, by starting the drug at a low dose and gradually increasing the dose, most patients can gradually tolerate it. In addition, long-term use of metformin should also pay attention to the risk of vitamin B12 deficiency. Due to its mechanism of action, diabetic patients with malnutrition should pay more attention to reasonable nutritional supplements when using dapagliflozin; at the same time, attention should also be paid to the risk of urinary tract infection and the increased risk of fractures. For patients with severe liver and kidney dysfunction, such as patients with glomerular filtration rate and less than 30, metformin and dapagliflozin are both contraindications and should be avoided.
The above knowledge introduction, I hope everyone can understand the advantages and disadvantages between metformin and dapagliflozin, and it will help you to make a reasonable choice of oral medication for diabetes. You are also welcome to actively forward and share it so that more people can see it. Get such health science knowledge.
