Glycemic Control and Cardiovascular Risk in Type 2 Diabetics Using Metformin vs. Combination Therapy

Introduction: Type 2 diabetes mellitus (T2DM) is a growing public health concern worldwide. While metformin is the first-line therapy, many patients require additional oral antidiabetic drugs (OADs) to achieve glycemic targets. Objective: To determine which is better at controlling blood sugar and lowering the risk of heart disease in people with type 2 diabetes: metformin monotherapy or combination treatment. Materials and Methods: The descriptive, cross-sectional research was conducted at the Department of Endocrinology at Jinnah Hospital in Lahore between February 2023 and January 2024. A total of 132 T2DM patients were enrolled using convenience sampling and divided into two groups: Group A (metformin only; n=62) and Group B (metformin plus OADs; n=70). Fasting blood glucose, HbA1c, blood pressure, and lipid profile were assessed. Independent samples t-tests were used to compare means between groups, with p<0.05 considered statistically significant. Results: Group B patients had far better blood sugar management than Group A patients. Their fasting blood sugar levels were 134.6 mg/dL compared to 144.2 mg/dL (p = 0.047), and their mean HbA1c levels were 7.36% compared to 7.94% (p = 0.002). Group B included 36 patients (51.43%) who were able to regulate their blood sugar levels (HbA1c <7%), whereas Group A had 18 patients (29.03%) who were able to do the same. In Group A, 39 patients (62.90%) and in Group B, 34 patients (48.57%) had dyslipidemia. There were 28 patients (45.16%) with high blood pressure in Group A and 29 patients (41.43%) in Group B. Conclusion: Combination therapy with metformin and other OADs was associated with better glycemic control compared to metformin monotherapy. However, no significant reduction in cardiovascular risk factors was observed. Further longitudinal studies are needed to explore long-term outcomes and safety, including hypoglycemia risk.