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Comparing Medications for Adults With Type 2 Diabetes

Slide: 29 of 35

Adverse Events and Side Effects: Monotherapy Versus Two-Drug Combination Therapy

Mild to Moderate Hypoglycemia
Moderate strength of evidence showed that the risk of hypoglycemia with metformin plus sulfonylurea or metformin plus a thiazolidinedione is higher than the risk with metformin alone. Moderate strength of evidence showed that metformin with a DPP-4 inhibitor has similar risk of hypoglycemia as metformin alone. 

Gastrointestinal (GI) Side Effects
Moderate strength of evidence showed that metformin monotherapy was associated with more frequent GI adverse events than the combination of metformin plus a second-generation sulfonylurea or metformin plus thiazolidinediones if the metformin component was a lower dose than the metformin monotherapy arm.

Hip and nonhip Fractures
High-grade evidence showed that thiazolidinediones, either in combination with another medication or as monotherapy, are associated with a higher risk of bone fractures compared with metformin alone or in combination with sulfonylurea.

Severe Lactic Acidosis
Moderate strength of evidence indicated that there is no increased risk of lactic acidosis in metformin users compared to those using a sulfonylurea or a combination of metformin and a sulfonylurea.