Treatment Strategies for Type 2 Diabetes

Combination Therapies for Type 2 Diabetes

Since many of the available classes of antidiabetic agents have complementary mechanisms of action, they can logically be used together, and such combinations have dem-onstrated an additive clinical benefit toward normalizing glycemic control. Many of these combinations have received FDA approval, and additional indications are being sought for others, especially those that have been shown to have clinical efficacy. These combinations include sulfonylurea and metformin, sulfonylurea and troglitazone, sulfonylurea and insulin, metformin and repaglinide, metformin and insulin, and acarbose and other modalities. One important result of the UKPDS was that multiple oral medications, also in combination with insulin injections in many cases, were required for intensive treatment so that accepted goals of HbA1c of approximately 7% could be achieved.

An example of complementary modes of action that show an additive effect for better glycemic control is the combination of a thiazolidinedione and a sulfonylurea. Clinical trials showed that glycemic control was improved by the combination of troglitazone with glyburide compared with glyburide monotherapy at 1 year. In a dose-dependent manner, HbA1c levels decreased 1.6% to 2.7% with 200 to 600 mg of troglitazone per day. At the 600-mg dose, 41% of patients reached HbA1c levels of less than 7% and 60% of patients reached HbA1c levels of less than 8%.[24]

One particularly interesting therapeutic combination that has re-ceived increasing attention is that of a thiazolidinedione and metformin. These are two equally effective treatments with different and complementary modes of action: troglitazone primarily increases peripheral insulin sensitivity and glucose disposal, and metformin lowers hepatic glucose production. In a small study, troglitazone and metformin combination therapy provided further improvement in glycemic control and was safe and well tolerated.[25] Based on efficacy demonstrated in pivotal clinical trials, the FDA has also recently granted approval for the clinical use of metformin in combination with either rosiglitazone or pioglitazone. This is a rational approach toward control of type 2 diabetes, since both medications enhance patients' insulin sensitivity. In addition, they both work independently of the pancreas so there is no risk of hypoglycemia, even when patients with well-controlled glucose levels are taking both of these medications.

Previous PageSection 9 of 12Drug Benefit Trends 11(11sb):11-34, 1999. © 1999 Cliggott Publishing, Division of SCP Communications
This is a part of article Treatment Strategies for Type 2 Diabetes Taken from "Buy Avandia Rosiglitazone" Information Blog