Type 2 diabetes is a complex disease with the coexistence of several pathophysiological abnormalities such as a defect of insulin secretion, a relative hyperglucagonaemia, an increased hepatic
glucose production and a muscular
insulin resistance. In order to tackle all these abnormalities, the coadministration of several drugs with complementary actions is frequently required.
Janumet is a fixed-dose combination of
sitagliptin, a specific inhibitor of dipeptidylpeptidase-4 that blocks the rapid degradation of so-called
incretin hormones (resulting in a potentiation of insulin secretion and reduction of
glucagon secretion in a
glucose-dependent manner), and of
metformin, a
biguanide compound that reduces
glucose hepatic production and slightly improves
insulin sensitivity. This pharmacological combination improves
glucose control without inducing hypoglycaemia or
weight gain. The tolerance profile is rather good, with (digestive) side effects and
contraindications (risk of
lactic acidosis in case of
renal insufficiency) attributable to
metformin.
Janumet (50/850 mg or 50/1.000 mg), twice daily, is indicated in the treatment of
type 2 diabetes and is currently reimbursed in Belgium after failure of
metformin monotherapy or the prior demonstration of the efficacy of adding sitaglitptin (
Januvia) to
metformin.