- It is quite common to come across patients prescribed a combination of sulfonylurea (SU) and a glinide.
- The logic seems to stem from the understanding that while SU are long-acting controlling fasting sugar, the glinides by virtue of being short-acting will counter post-meal spikes.
- The fallacy (1) in this argument: Glipizide and gliclazide are short-acting SUs. Glimepiride is a long-acting SU. The meglitinides are short-acting agents. Hence the concept of SU being long-acting and meglitinides being short-acting is not correct.
- Fallacy number 2: There is a clear recommendation not to combine two groups of oral hypoglycemic agents with similar mechanism of action (Kenneth R, https://www.ncbi.nlm.nih.gov/books/NBK279141/). There is no additional glycemic benefit, but the risk of hypoglycemia increases by several fold. Hence, this commination should not be used in clinical practice.
