Is Combination Antihyperglycemic Therapy Superior To Monotherapy As An Initial Type 2 Diabetes Treatment?
Is Combination Antihyperglycemic Therapy Superior to Monotherapy as an Initial Type 2 Diabetes Treatment? Karin Sterl, MD, and Kim A. Carmichael, MDSeries Editor Q.What is the rationale behind starting initial combination therapy in patients with type 2 diabetes? A.Since type 2 diabetes is associated with multiple physiologic abnormalities, combination therapy may help address many of these concerns concomitantly so as to minimize side effects and provide rapid metabolic balance. Understanding the mechanisms of action of the differing agents will help the clinician choose the optimal regimen for any given patient. Q.What are the most common oral hypoglycemic agents used in the initial therapy of type 2 diabetes? A.The American Diabetes Association (ADA) recommends biguanides (eg, metformin in the United States), if not contraindicated, as the initial agent for treatment of type 2 diabetes.1 Metformin works by decreasing glucose production by the liver and increasing glucose uptake into the muscles. It can decrease hemoglobin A1c (HbA1c) values by 1.5% to 2%. It is contraindicated in patients with renal insufficiency (creatinine levels >1.4 mg/dL in females and >1.5 mg/dL in males) Continue reading >>