使用兩種以上藥物組合控制血糖

先看A1C 是否超過 8.5, 如果小於 8.5., 使用 metformin 治療, 但如果有高血糖症狀則建議打胰島素
A1C 如果在 8.5% 以上, 建議使用 Metformin 加上其他藥物 Metformin 可以與所有其他藥物組合

SGLT2i 可減重, 美國臨床內分泌學會推薦的Metformin 組合

SU和 Glinide 不建議並用
DPP4i 與 GLP1RA 不建議並用
Combination therapy of oral hypoglycemic agents in patients with type 2 diabetes mellitus

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5668409/

這篇是韓國內科醫學雜誌的文章. 

美國糖尿病學會沒有特定推薦哪一種藥物搭配metformin作為第二種組合藥物

美國臨床內分泌學會則推薦, 先選 SGLT2i, 因為有減重效果. 

There are six major classes of antidiabetic agents that can be combined with metformin. They are sulfonylurea (SU), thiazolidinediones (TZDs), dipeptidyl peptidase-4 inhibitors (DPP4i), sodium-glucose cotransporter-2 inhibitors (SGLT2i), glucagon-like peptide-1 receptor agonists, and insulin. The American Diabetes Association does not prioritize any specific medication and recommends physicians to choose one based on their efficacy, hypoglycemic risk, weight effects, side-effects, and cost [4]. However, the American Association of Clinical Endocrinologists recommended the SGLT2i first, followed by DPP4i, TZD, α-glucosidase inhibitors, and SU among the OHAs, mainly based on the weight-reducing effect [5]. In this paper, we provide a comparative review among the OHAs based on meta-analyses and suggest a guide to select one as a first-combination medication with metformin.