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What Is The First Line Of Treatment For Type 2 Diabetes?

Second And Third-line Therapy For Patients With Diabetes (optimal Use Project)

Second And Third-line Therapy For Patients With Diabetes (optimal Use Project)

Second and Third-Line Therapy for Patients With Diabetes (Optimal Use Project) In combination with lifestyle measures (weight control, proper nutrition, and adequate exercise), medications, such as metformin and sulfonylureas, play an important role in achieving glycemic control in patients with diabetes mellitus: Metformin is a popular first-line oral antidiabetes drug that is used to help control glycemic levels in patients with diabetes when lifestyle modifications alone are insufficient. Because diabetes is a progressive disease, metformin monotherapy may eventually fail to adequately control glycemic levels. At this point, most patients need one or more oral antidiabetes drug, or insulin, added as a second-line therapy to their treatment regimen. If, after time, second-line therapy fails, most patients will need one or more additional drugs added as a third-line therapy to achieve target glycemic levels. In Canada, seven classes of antidiabetes drugs are available that maybe used as second- and third-line therapy: sulfonylureas, meglitinides, alpha-glucosidase inhibitors, thiazolidinediones, incretin agents, weight loss agents, and insulins (human and insulin analogues). When metformin monotherapy is no longer effective, existing guidelines recommend several options. However, these guidelines generally lack specific recommendations regarding which drug(s) are optimal as second- and third-line therapy. Instead, they typically recommend that a stepwise approach be used to add drugs from various classes. Moreover, guideline recommendations in this area are based primarily on evidence regarding clinical efficacy and safety; cost-effectiveness is often not considered. Given the large, growing population of patients with diabetes in Canada, suboptimal use of second- and Continue reading >>

Type 2 Diabetes

Type 2 Diabetes

Print Diagnosis To diagnose type 2 diabetes, you'll be given a: Glycated hemoglobin (A1C) test. This blood test indicates your average blood sugar level for the past two to three months. It measures the percentage of blood sugar attached to hemoglobin, the oxygen-carrying protein in red blood cells. The higher your blood sugar levels, the more hemoglobin you'll have with sugar attached. An A1C level of 6.5 percent or higher on two separate tests indicates you have diabetes. A result between 5.7 and 6.4 percent is considered prediabetes, which indicates a high risk of developing diabetes. Normal levels are below 5.7 percent. If the A1C test isn't available, or if you have certain conditions — such as if you're pregnant or have an uncommon form of hemoglobin (known as a hemoglobin variant) — that can make the A1C test inaccurate, your doctor may use the following tests to diagnose diabetes: Random blood sugar test. A blood sample will be taken at a random time. Blood sugar values are expressed in milligrams per deciliter (mg/dL) or millimoles per liter (mmol/L). Regardless of when you last ate, a random blood sugar level of 200 mg/dL (11.1 mmol/L) or higher suggests diabetes, especially when coupled with any of the signs and symptoms of diabetes, such as frequent urination and extreme thirst. Fasting blood sugar test. A blood sample will be taken after an overnight fast. A fasting blood sugar level less than 100 mg/dL (5.6 mmol/L) is normal. A fasting blood sugar level from 100 to 125 mg/dL (5.6 to 6.9 mmol/L) is considered prediabetes. If it's 126 mg/dL (7 mmol/L) or higher on two separate tests, you have diabetes. Oral glucose tolerance test. For this test, you fast overnight, and the fasting blood sugar level is measured. Then you drink a sugary liquid, and blood s Continue reading >>

Metformin Remains Best First-line Therapy For Type 2 Diabetes

Metformin Remains Best First-line Therapy For Type 2 Diabetes

Metformin Remains Best First-line Therapy for Type 2 Diabetes Metformin should remain the first choice for the treatment of type 2 diabetes, even in the face of competition from a host of newer agents, concludes a new review. Nisa M Maruthur, MD, of Johns Hopkins University School of Medicine, Baltimore, Maryland, led the review, published today in the Annals of Internal Medicine. "We conclude that metformin should remain a first-line therapy because its effect on HbA1c is similar to other medications. Metformin has a long-term safety profile, it's weight neutral or helps people lose weight, it has gastrointestinal side effects but they are avoidable or tolerable, and of course metformin looks better for cardiovascular mortality than sulfonylureas," she told Medscape Medical News in an interview. Among the drugs evaluated along with metformin were the latest approvals for type 2 diabetes, including the newest class of sodiumglucose cotransporter 2 (SGLT2) inhibitors, the dipeptidyl peptidase-4 (DPP-4) inhibitors, and glucagonlike peptide-1 (GLP-1) receptor agonists. Other drugs reviewed were thiazolidinediones, sulfonylureas, and selected metformin-based combinations. Asked to comment, Darren McGuire, MD, of the University of Texas Southwestern Medical Center, Dallas, remarked: "I do find it odd that the justification for metformin first hinges on its comparison with sulfonylureas, which have minimal data available suggesting efficacy and ongoing concern about adverse cardiovascular effects. "That is, it is possible that sulfonylureas have adverse outcomes, which of course in these analyses will exaggerate what, if any, cardiovascular risk efficacy metformin has." Review Includes Latest Data on Newer Agents Amid the plethora of newly approved antidiabetic drugs and an Continue reading >>

Metformin As Firstline Treatment For Type 2 Diabetes: Are We Sure?

Metformin As Firstline Treatment For Type 2 Diabetes: Are We Sure?

Metformin as firstline treatment for type 2 diabetes: are we sure? Metformin as firstline treatment for type 2 diabetes: are we sure? BMJ 2016; 352 doi: (Published 08 January 2016) Cite this as: BMJ 2016;352:h6748 Catherine Cornu, clinical research physician 2 3 4 1Department of General Practice, Faculty of Poitiers, 86000 Poitiers, France 2UMR 5558, Laboratoire de Biomtrie et Biologie Evolutive, Claude Bernard University. CNRS, Lyon, France 3Louis Pradel Hospital, Lyon University, Lyon, France 4INSERM Clinical Investigation Centre (CIC1407), Lyon, France Correspondence to: R Boussageon, 11 route du Clos Bardien, 79290 Saint Martin de Sanzay, France remy.boussageon2{at}wanadoo.fr Rmy Boussageon and colleagues ask whether metformin is bringing practical benefit to patients and question the focus on surrogate measures Competing interests: We have read and understood BMJ policy on declaration of interests and have no relevant interests to declare. Contributors and sources: This article is the result of joint discussions conducted by three authors on the effectiveness of antidiabetic drugs in type 2 diabetes. RM is experienced in meta-analysis, especially in glucose lowering drugs. FG is experienced in pharmacology and evidence based medicine and has done several meta-analyses. CC is an endocrinologist and is experienced in meta-analysis. She is a former member of a health authority working group on glucose lowering drugs in type 2 diabetes. All authors contributed to study conceptualisation and design, data collection, and analysis. RM drafted the manuscript, which was revised by FG and CC. All authors approved the final manuscript. Provenance and peer review: Not commissioned; externally peer reviewed. Continue reading >>

Patient Education: Diabetes Mellitus Type 2: Treatment (beyond The Basics)

Patient Education: Diabetes Mellitus Type 2: Treatment (beyond The Basics)

TYPE 2 DIABETES OVERVIEW Type 2 diabetes mellitus occurs when the pancreas (an organ in the abdomen) produces insufficient amounts of the hormone insulin and/or the body becomes resistant to normal or even high levels of insulin. This causes high blood sugar (glucose) levels, which can lead to a number of complications if untreated. People with type 2 diabetes require regular monitoring and ongoing treatment to maintain normal or near-normal blood sugar levels. Treatment includes lifestyle adjustments, self-care measures, and medicines, which can minimize the risk of diabetes and cardiovascular (heart-related) complications. This topic review will discuss the treatment of type 2 diabetes. Topics that discuss other aspects of type 2 diabetes are also available: (See "Patient education: Diabetes mellitus type 2: Overview (Beyond the Basics)".) (See "Patient education: Diabetes mellitus type 2: Alcohol, exercise, and medical care (Beyond the Basics)".) TYPE 2 DIABETES TREATMENT GOALS Blood sugar control — The goal of treatment in type 2 diabetes is to keep blood sugar levels at normal or near-normal levels. Careful control of blood sugars can help prevent the long-term effects of poorly controlled blood sugar (diabetic complications of the eye, kidney, nervous system, and cardiovascular system). Home blood sugar testing — In people with type 2 diabetes, home blood sugar testing might be recommended, especially in those who take certain oral diabetes medicines or insulin. Home blood sugar testing is not usually necessary for people who are diet controlled. (See "Patient education: Self-monitoring of blood glucose in diabetes mellitus (Beyond the Basics)".) A normal fasting blood sugar is less than 100 mg/dL (5.6 mmol/L), although some people will have a different goal. Continue reading >>

Afp Journal Club: Choosing First-line Therapy For Management Of Type 2 Diabetes - American Family Physician

Afp Journal Club: Choosing First-line Therapy For Management Of Type 2 Diabetes - American Family Physician

Choosing First-Line Therapy for Management of Type 2 Diabetes MARK A. GRABER, MD, University of Iowa Carver College of Medicine, Iowa City, Iowa ANDREA DARBY-STEWART, MD, Mayo Clinic Family Medicine Residency Program, Scottsdale, Arizona ROBERT DACHS, MD, FAAFP, St. Clare's Family Practice Residency Program, Schenectady, New York Am Fam Physician.2008Jan1;77(1):16-17. From left: Dr. Mark Graber, Dr. Andrea Darby-Stewart, and Dr. Robert Dachs Each month, three presenters will review an interesting journal article in a conversational manner. These articles will involve hot topics that affect family physicians or will bust commonly held medical myths. The presenters will give their opinions about the clinical value of the studies discussed. The opinions reflect the views of the presenters, not those of AFP or the AAFP. Kahn SE, Haffner SM, Heise MA, et al., for the ADOPT Study Group. Glycemic durability of rosiglitazone, metformin, or glyburide monotherapy [published correction appears in N Engl J Med. 2007;356(13):13871388]. N Engl J Med. 2006;355(23):24272443. Which controls type 2 diabetes best at five years: rosiglitazone, metformin, or glyburide? Mark: For the estimated 20 million Americans with type 2 diabetes, this is a very important question. This article is an excellent demonstration of why reading just the abstract could lead you to the wrong conclusion. Mark: This study randomized 4,360 patients to monotherapy with rosiglitazone (Avandia), metformin (Glucophage), or glyburide (Micronase). The end point was fasting blood glucose over 180 mg per dL. The authors concluded that, at five years, only 15 percent of patients taking rosiglitazone failed mono-therapy versus 21 percent of those taking metformin and 34 percent taking glyburide. Although the abstract trump Continue reading >>

Guideline Approach To Therapy In Patients With Newly Diagnosed Type 2 Diabetes

Guideline Approach To Therapy In Patients With Newly Diagnosed Type 2 Diabetes

Both the prevalence and incidence of type 2 diabetes are increasing worldwide in conjunction with increased Westernization of the population's lifestyle. Type 2 diabetes is still a leading cause of cardiovascular disease (CVD), amputation, renal failure, and blindness. The risk for microvascular complications is related to overall glycemic burden over time as measured by A1C (1,2). The UK Prospective Diabetes Study (UKPDS) 10-year follow-up demonstrated a possible effect on CVD as well (3). A meta-analysis of cardiovascular outcome in patients with long disease duration including Action to Control Cardiovascular Risk in Diabetes (ACCORD), Action in Diabetes and Vascular Disease: Preterax and Diamicron MR Controlled Evaluation (ADVANCE), and Veterans Affairs Diabetes Trial (VADT) suggested that in these populations the reduction of ~1% in A1C is associated with a 15% relative reduction in nonfatal myocardial infarction (4). Most antihyperglycemic drugs besides insulin reduce A1C values to similar levels (5) but differ in their safety elements and pathophysiological effect. Thus, there is a need for recommending a drug therapy preference. While the positive effects on prevention of microvascular complications were demonstrated with the various antihyperglycemic drugs (1,2,6,7), several questions are left open regarding this therapy in newly diagnosed type 2 diabetes: What is the comparative effectiveness of antihyperglycemic drugs on other long-term outcomes, i.e., β-cell function and cardiovascular morbidity and mortality? What is the comparative safety of these treatments, and do they differ across subgroups of adults with type 2 diabetes? Should we combine antihyperglycemic drugs at the time of diagnosis according to their pathophysiological effect to address the diff Continue reading >>

The Safest First-line Therapy For Type 2 Diabetes

The Safest First-line Therapy For Type 2 Diabetes

According to more than 200 studies involving 1.4 million patients, metformin reduces heart disease risk in diabetes patients more effectively than its competitors. A recent meta-analysis, published in the Annals of Internal Medicine, found metformin, widely used for treating type 2 diabetes (T2D), was safer for the heart than many newer competitors. Metformin showed particularly dramatic results when compared to sulfonylurea, its closest competitor drug, reducing the relative risk of a patient dying from heart disease by about 30 – 40 percent. To evaluate the comparative effectiveness and safety of monotherapy (thiazolidinediones, metformin, sulfonylureas, dipeptidyl peptidase-4 [DPP-4] inhibitors, sodium–glucose cotransporter 2 [SGLT-2] inhibitors, and glucagon-like peptide-1 [GLP-1] receptor agonists) and selected metformin-based combinations in adults with type 2 diabetes were evaluated. English-language studies from MEDLINE, EMBASE, and the Cochrane Central Register of Controlled Trials, indexed from inception through March 2015 (MEDLINE search updated through December 2015). Paired reviewers independently identified 179 trials and 25 observational studies of head-to-head monotherapy or metformin-based combinations. And two reviewers independently assessed study quality and serially extracted data and graded the strength of evidence. The results showed that cardiovascular mortality was lower for metformin versus sulfonylureas; the evidence on all-cause mortality, cardiovascular morbidity, and microvascular complications was insufficient or of low strength. Reductions in hemoglobin A1C values were similar across monotherapies and metformin-based combinations, except that DPP-4 inhibitors had smaller effects. Body weight was reduced or maintained with metformin, D Continue reading >>

Metformin Showed Best Results For First-line Treatment Of Type 2 Diabetes

Metformin Showed Best Results For First-line Treatment Of Type 2 Diabetes

Metformin showed best results for first-line treatment of type 2 diabetes Metformin, in combination or alone, appears to be the top choice for first-line treatment of type 2 diabetes because it demonstrates the best risk-benefit profile vs. other diabetes drugs, according to new data. Researchers performed a comprehensive systematic review of 140 randomized clinical trials and 26 observational studies that analyzed the safety and efficacy of various diabetes medications, including metformin, second-generation sulfonylureas, thiazolidinediones, meglitinides, dipeptidyl peptidase-4 (DPP-4) inhibitors and glucagon-like peptide-1 receptor agonists. Studies that examined the drugs used alone or in combination were included. Results indicated that most medications used as monotherapy yielded comparable decreases in HbA1c (about one absolute percentage point on average throughout the course of a study). Metformin alone, however, lowered HbA1c more than DPP-4 inhibitors alone, and any type of combination therapy reduced HbA1c by about one absolute percentage point more than monotherapy. Weight loss with metformin was a mean 2.5 kg more vs. TZDs and sulfonylureas. Other data also showed that combination metformin and GLP-1 agonists induced greater weight loss than other combination therapies, but the researchers said evidence supporting this finding was weak. When compared with pioglitazone, sulfonylureas and DPP-4 inhibitors, metformin also significantly lowered LDL. Further, the drug decreased triglycerides and moderately raised HDL. The researchers reported that sulfonylureas raised the risk for hypoglycemia fourfold vs. metformin monotherapy. Combination treatment with metformin and a sulfonylurea also had a sixfold higher risk for hypoglycemia than combination metformin an Continue reading >>

Diabetes Treatment

Diabetes Treatment

Treatment of diabetes depends on which type of diabetes a patient has, either type 1 diabetes or type 2 diabetes. Type 1 diabetes occurs when the body does not produce insulin, so replacement insulin must be delivered by injection, pump, or inhalation. People who have type 1 diabetes need to carefully plan and follow meals, timing of meals, and activity to keep their blood glucose (sugar) in check. It's important to measure blood sugar levels as low blood sugar can be dangerous, too. Type 2 diabetes occurs when either the body makes too little insulin or the cells do not respond to insulin that is produced ("insulin resistance"). Patients with type 2 diabetes or prediabetes may be able to control their blood sugar levels by following a diet, exercise program and losing excess weight. If this first-line treatment does not control blood sugar levels effectively, an oral medication, often metformin first with other medications if needed, can be added to the treatment plan. Patients with type 2 diabetes may also need injected insulin, and in some circumstances it may be used as the first medication. Patients and/or family members must learn to inject insulin if it is prescribed. In addition, patients with diabetes must learn to check and follow their blood sugar levels. In addition to medications to control glucose, many patients with diabetes also need to take medicines to lower their blood pressure and cholesterol levels. When diet and exercise aren't satisfactory, weight loss medications such as Belviq, Contrave, Xenical, or Qsymia can also be used to help with the management of obesity. Statins, such as atorvastatin (Lipitor), rosuvastatin (Crestor), or pravastatin (Pravachol) are typically first-line prescription treatment for high cholesterol, also along with diet and Continue reading >>

Metformin Best As First Type 2 Diabetes Treatment

Metformin Best As First Type 2 Diabetes Treatment

MONDAY, Jan. 2, 2017 (HealthDay News) -- Newly updated guidelines reaffirm that metformin is the first-line drug for people with type 2 diabetes , and that several other medications -- including newer ones -- can be added if needed. The recommendations come from the American College of Physicians (ACP). The American Academy of Family Physicians endorsed the new guidelines. The ACP updated the guidelines because of new research into diabetes drugs, and the U.S. Food and Drug Administration approval of new diabetes drugs. "Metformin, unless contraindicated, is an effective treatment strategy because it has better effectiveness, is associated with fewer adverse effects, and is cheaper than most other oral medications," ACP president Dr. Nitin Damle said in a college news release. "The escalating rates of obesity in the U.S. are increasing the incidence and prevalence of diabetes substantially. Metformin has the added benefit of being associated with weight loss ," Damle said. The ACP recommends that if a patient needs to take a second drug by mouth to lower blood sugar levels , physicians should look at adding a sulfonylurea, thiazolidinedione, SGLT-2 inhibitor, or a DPP-4 inhibitor. Examples of sulfonylurea drugs include glyburide ( Diabeta , Glucovance , Micronase ), glimepiride , glipizide ( Glucotrol ) and tolbutamide . Thiazolidinedione drugs include pioglitazone (Actos) and rosiglitazone (Avandia). SGLT-2 inhibitors include canagliflozin (Invokana), empagliflozin (Jardiance) and dapagliflozin (Farxiga). DPP-4 inhibitors include sitagliptin ( Janumet , Januvia ) or linagliptin (Jentadueto, Tradjenta). Brand names for metformin include Glumetza , Glucophage , and Fortamet . "Adding a second medication to metformin may provide additional benefits," Damle said. "However Continue reading >>

Metformin Should Be First-line Treatment For Type 2 Diabetes: Ada

Metformin Should Be First-line Treatment For Type 2 Diabetes: Ada

Metformin should be first-line treatment for type 2 diabetes: ADA NEW YORK (Reuters Health) - Metformin should be the first-line treatment for type 2 diabetes, and combination drug therapy, when needed, should be started sooner, according to the American Diabetes Association (ADA). Those and other recommendations in the ADAs 2017 Standards of Medical Care are summarized in a synopsis by Dr. James Chamberlain of St. Marks Diabetes Center in Salt Lake City, Utah, and colleagues, online March 13 in Annals of Internal Medicine. For the 2017 update, the multidisciplinary ADA Professional Practice Committee systematically searched MEDLINE from January through November 2016 to add, clarify, or revise earlier recommendations based on new evidence. The full 142-page document was released in January and is online here: There are several important points of emphasis for providers, Dr. Chamberlain told Reuters Health by email. First, metformin, along with lifestyle modification, remains the preferred initial drug therapy for type 2 diabetes and recent changes to the metformin label by the FDA allow its use in patients with more advanced renal disease. Next, earlier use of combination drug therapy is urged to help achieve and maintain glycemic control, he said. We urge providers to add a second oral agent, a GLP-1 receptor agonist, or basal insulin therapy when HbA1c goals are not being achieved. According to the ADA, If the patient has a random glucose level of 16.7 mmol/L (300 mg/dL) or greater or an HbA1c level of 10% or greater and has acute symptoms of polyuria, polydipsia, or weight loss, combination therapy that includes insulin should be considered. The ADA also advises that if the HbA1c target has not been achieved within approximately three months of starting treatment, t Continue reading >>

Type 2 Diabetes Mellitus Treatment & Management

Type 2 Diabetes Mellitus Treatment & Management

Approach Considerations The goals in caring for patients with diabetes mellitus are to eliminate symptoms and to prevent, or at least slow, the development of complications. Microvascular (ie, eye and kidney disease) risk reduction is accomplished through control of glycemia and blood pressure; macrovascular (ie, coronary, cerebrovascular, peripheral vascular) risk reduction, through control of lipids and hypertension, smoking cessation, and aspirin therapy; and metabolic and neurologic risk reduction, through control of glycemia. New abridged recommendations for primary care providers The American Diabetes Association has released condensed recommendations for Standards of Medical Care in Diabetes: Abridged for Primary Care Providers, highlighting recommendations most relevant to primary care. The abridged version focusses particularly on the following aspects: The recommendations can be accessed at American Diabetes Association DiabetesPro Professional Resources Online, Clinical Practice Recommendations – 2015. [117] Type 2 diabetes care is best provided by a multidisciplinary team of health professionals with expertise in diabetes, working in collaboration with the patient and family. [2] Management includes the following: Ideally, blood glucose should be maintained at near-normal levels (preprandial levels of 90-130 mg/dL and hemoglobin A1C [HbA1c] levels < 7%). However, focus on glucose alone does not provide adequate treatment for patients with diabetes mellitus. Treatment involves multiple goals (ie, glycemia, lipids, blood pressure). Aggressive glucose lowering may not be the best strategy in all patients. Individual risk stratification is highly recommended. In patients with advanced type 2 diabetes who are at high risk for cardiovascular disease, lowering Hb Continue reading >>

Jama Study Shows That Metformin Is Safest First-line Therapy For Type 2 Diabetes

Jama Study Shows That Metformin Is Safest First-line Therapy For Type 2 Diabetes

Twitter summary: JAMA study shows that metformin is safest first-line therapy for type 2 diabetes – future GRADE study to show best second-line therapy The journal JAMA Internal Medicine recently published results from a study comparing the effectiveness of four different classes of drugs for type 2 diabetes: metformin, sulfonylureas, TZDs, and DPP-4 inhibitors. The study was a “retroactive cohort study,” meaning that it looked back at a group of patients and analyzed their health outcomes. The results showed that metformin is the best drug to begin treatment of type 2 diabetes – patients starting drugs other than metformin had on average a significantly greater risk of needing additional medications down the road (another oral pill and/or insulin), without any additional health benefits (e.g., they did not have reduced hypoglycemia, ER visits, or heart problems). Surprisingly, the research found that despite guidelines recommending metformin, only 58% of patients actually used metformin as their first diabetes medication. The study unfortunately did not include GLP-1 agonists – a common injectable drug class for treating type 2 diabetes that has been available since 2005. It was very depressing in our view that GLP-1 wasn’t assessed. In the future, we look forward to the results of the GRADE study, which aims to conclude which second-line drug for type 2 diabetes is most effective; unfortunately, however, this study will not include SGLT-2 inhibitors or any fixed dose combination drugs, which we believe will be a very limiting factor from understanding real life outcomes. While we understand that few risks are attractive for those designing the studies, we believe SGLT-2 research could have been included as a useful arm. For more resources on treatment reco Continue reading >>

Guideline Approach To Therapy In Patients With Newly Diagnosed Type 2 Diabetes

Guideline Approach To Therapy In Patients With Newly Diagnosed Type 2 Diabetes

Both the prevalence and incidence of type 2 diabetes are increasing worldwide in conjunction with increased Westernization of the population's lifestyle. Type 2 diabetes is still a leading cause of cardiovascular disease (CVD), amputation, renal failure, and blindness. The risk for microvascular complications is related to overall glycemic burden over time as measured by A1C (1,2). The UK Prospective Diabetes Study (UKPDS) 10-year follow-up demonstrated a possible effect on CVD as well (3). A meta-analysis of cardiovascular outcome in patients with long disease duration including Action to Control Cardiovascular Risk in Diabetes (ACCORD), Action in Diabetes and Vascular Disease: Preterax and Diamicron MR Controlled Evaluation (ADVANCE), and Veterans Affairs Diabetes Trial (VADT) suggested that in these populations the reduction of ~1% in A1C is associated with a 15% relative reduction in nonfatal myocardial infarction (4). Most antihyperglycemic drugs besides insulin reduce A1C values to similar levels (5) but differ in their safety elements and pathophysiological effect. Thus, there is a need for recommending a drug therapy preference. While the positive effects on prevention of microvascular complications were demonstrated with the various antihyperglycemic drugs (1,2,6,7), several questions are left open regarding this therapy in newly diagnosed type 2 diabetes: What is the comparative effectiveness of antihyperglycemic drugs on other long-term outcomes, i.e., β-cell function and cardiovascular morbidity and mortality? What is the comparative safety of these treatments, and do they differ across subgroups of adults with type 2 diabetes? Should we combine antihyperglycemic drugs at the time of diagnosis according to their pathophysiological effect to address the diff Continue reading >>

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