Nonbiguanide

Nonbiguanide is a term used in pharmacology to describe substances that do not belong to the biguanide class. In the context of diabetes management, biguanides refer primarily to metformin and related compounds that share the biguanide chemical structure. Nonbiguanide refers to all other glucose-lowering therapies that are not biguanides. The term is not a formal pharmacological subclass; rather, it is used to contrast metformin-based therapy with other drug classes.

Nonbiguanide therapies include insulin and non-insulin agents such as sulfonylureas (glipizide, glyburide), meglitinides (repaglinide), thiazolidinediones (pioglitazone), DPP-4 inhibitors (sitagliptin), GLP-1 receptor agonists (liraglutide), SGLT2 inhibitors (empagliflozin), and α-glucosidase inhibitors (acarbose). The choice among nonbiguanide options depends on factors like patient comorbidity, hypoglycemia risk, weight effects, renal function, and tolerability. Some agents have cardiovascular or renal benefits beyond glycemic control (notably SGLT2 inhibitors and GLP-1 receptor agonists).

Terminology note: "nonbiguanide" is descriptive rather than prescriptive and may be used in literature to distinguish metformin-based strategies from other therapies. It does not denote a single drug or a unified mechanism of action.

History: Biguanides emerged in the early 20th century; metformin became the prototypical drug in this class, approved for type 2 diabetes in the 1990s. As therapies expanded, the term "nonbiguanide" became a broad label for alternatives.