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. 2025 Sep;12(3):457-466.
doi: 10.1007/s40801-025-00502-0. Epub 2025 Jul 10.

Effectiveness of Glipizide and Glipizide Plus Metformin Formulation among Asian Indians with Type 2 Diabetes: a Real-World, Retrospective Electronic Medical Record Analysis

Thyparambil Aravindakshan PramodKumar  1 , Rajendra Pradeepa  1 , Saravanan Jebarani  2 , Sadasivam Ganesan  2 , Abhijit Pednekar  3 , Routray Philips  4 , Suraparaju Pavan Kumar  4 , Ranjit Unnikrishnan  5 , Ranjit Mohan Anjana  5 , Viswanathan Mohan  6
Affiliations

Effectiveness of Glipizide and Glipizide Plus Metformin Formulation among Asian Indians with Type 2 Diabetes: a Real-World, Retrospective Electronic Medical Record Analysis

Thyparambil Aravindakshan PramodKumar et al. Drugs Real World Outcomes. 2025 Sep.

Abstract

Background: In low- and middle-income countries, sulfonylureas are commonly prescribed due to cost-effectiveness. However, data comparing their real-world impact, especially when used alone versus in combination with metformin, remain limited.

Objective: This study aimed to assess the effectiveness of glipizide and glipizide plus metformin in individuals with type 2 diabetes (T2D) using real-world data.

Methods: Data was obtained from 11,949 individuals with T2D who were prescribed either glipizide or glipizide+metformin and had at least one follow-up within 1 year at a tertiary diabetes care centre in India. The primary outcome was the change in glycated hemoglobin (HbA1c) levels from baseline to follow-up. Secondary outcomes included changes in fasting plasma glucose (FPG), postprandial glucose (PPG), body mass index (BMI), and estimated glomerular filtration rate (eGFR).

Results: The mean age of participants was 56 ± 11 years, 59% (n = 7008) were male, and the mean diabetes duration was 10.2 ± 8 years. In the glipizide group (n = 6034), HbA1c decreased from 8.8% to 7.9% (p < 0.001), FPG decreased by 16 mg/dL (p < 0.001), and PPG decreased by 29 mg/dL (p < 0.001). In the glipizide + metformin group (n = 5915), HbA1c levels declined from 8.9% to 7.8% (p < 0.001), and FPG and PPG declined by 23 mg/dL and 44 mg/dL, respectively (p < 0.001). BMI remained stable in the glipizide group, while a reduction of 0.2 kg/m2 was observed among overweight/obese individuals in the glipizide + metformin group. The use of glipizide and glipizide + metformin effectively improved glycemic control without adverse anthropometric changes. C-peptide levels were preserved across all treatment groups, demonstrating sustained β-cell function. HbA1c reductions were observed consistently across all eGFR categories. Furthermore, as glipizide plus metformin is one of the least expensive antidiabetic drugs in India (₹1460/year [$16.87]) it can help improve accessibility to treatment even among those in lower socio-economic statuses.

Conclusions: Glipizide as monotherapy or in combination with metformin, significantly improved glycemic control even in those with decreasing renal function, with no adverse effects on weight and with preservation of β-cell function. While long-term studies are needed to assess the sustainability of these benefits, glipizide can be considered a cost-effective therapeutic option for T2D in low- and middle-income countries.

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Conflict of interest statement

Declarations. Funding: This work was supported by USV Private Limited. Ethics Approval : The study was conducted in accordance with the Declaration of Helsinki, and approved by the Institutional Review Board (or Ethics Committee) of Madras Diabetes Research Foundation (protocol code: MDRF/NCT/03-02/2024 and date of approval 9 April 2024). Author Contributions: Conceptualization: Ranjit Unnikrishnan, Ranjit Mohan Anjana, and Viswanathan Mohan. Data curation: Saravanan Jebarani and Sadasivam Ganesan. Formal analysis: Thyparambil Aravindakshan Pramodkumar and Rajendra Pradeepa. Funding acquisition: Viswanathan Mohan. Methodology: Ranjit Unnikrishnan, Ranjit Mohan Anjana, and Viswanathan Mohan. Resources: Rajendra Pradeepa. Software: Saravanan Jebarani. Validation: Rajendra Pradeepa. Writing—original draft: Thyparambil Aravindakshan Pramodkumar. Writing—review & editing: Rajendra Pradeepa, Saravanan Jebarani, Sadasivam Ganesan, Abhijit Pednekar, Routray Philips, Suraparaju Pavan Kumar, Ranjit Unnikrishnan, Ranjit Mohan Anjana, and Viswanathan Mohan. All authors read and approved the final version. Consent to Participate : Informed consent was obtained from all subjects involved in the study. Data Availability: The data presented in this study are available on request from the corresponding author. The data are not publicly available due to containing information that could compromise the privacy of research participants. Conflict of Interest: The authors declare no competing interests associated with this manuscript. Abhijit Pednekar is a full-time employee of USV Private Limited, Mumbai, India, which supported this research project. Code availability: Not applicable. Consent for publication: Not applicable.

Figures

Fig. 1
Fig. 1
Study flow chart
Fig. 2
Fig. 2
Changes in HbA1c from baseline to follow-up in subgroups by HbA1c category among individuals with type 2 diabetes treated with glipizide (a) and glipizide + metformin (b)
Fig. 3
Fig. 3
Changes in BMI from baseline to follow-up in subgroups by BMI category among individuals with type 2 diabetes treated with glipizide (a) and glipizide + metformin (b)
Fig. 4
Fig. 4
Changes in HbA1c from baseline to follow-up in subgroups by eGFR stages among individuals with type 2 diabetes treated with glipizide (a) and glipizide + metformin (b)
See this image and copyright information in PMC

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