The place of fixed combination of sulfonylurea derivatives and metformin in the modern treatment paradigm for type 2 diabetes mellitus

The evolution of type 2 diabetes mellitus (T2DM) treatment has contributed to the emergence of a disease-modifying, cardio-renal-hepatocentric approach in the global medical community. This has shifted the focus of therapy from simple glycemic control to comprehensive organ protection, driven by a growing understanding of the relationship between hyperglycemia and the development of cardiovascular, renal, and hepatic complications. Current clinical guidelines emphasize the importance of combining hypoglycemic agents with additional organ-protective properties, such as sodium-glucose cotransporter type 2 inhibitors (SGLT2 inhibitors) and glucagon-like peptide-1 receptor agonists (GLP-1 agonists). At the same time, it is noted that for patients with low and moderate risk of complications and limited resources, traditional medications, primarily metformin and sulfonylurea derivatives (SU), remain relevant. This review analyzes current recommendations for the treatment of type 2 diabetes mellitus (T2DM) and provides a detailed discussion of the advantages and limitations of sulfonylureas (SUs), as well as the fixed-dose combination of glibenclamide and metformin (Glucovance). This combination offers a synergistic effect, high glucose-lowering activity, cost-effectiveness, and ease of use, which is especially important for patients with marked hyperglycemia and low adherence to therapy. The article discusses the indications for prescribing the fixed-dose combination based on the T2DM phenotype, compares the pros and cons of “old” and “new” medications, and evaluates the potential for combining sulfonylureas and metformin with modern organoprotective agents.

Glucovance remains a popular and effective tool in the endocrinologist’s arsenal, especially when balancing treatment efficacy, safety, and cost.

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