Treatment of type 2 diabetes has come a long way in a few years. Until 1994, the only drug options in the United States were sulfonylureas and insulin. Today, there are four additional classes of glucose-lowering drugs.
Diet and exercise remain the cornerstones of treatment. Medication is indicated when lifestyle measures fail to achieve the recommended hemoglobin [A.sub.1c] value within 2-4 months. Oral agents are usually the first line of drug treatment. Patients who present with exceptionally high blood glucose levels or symptoms such as polyuria, polydipsia, and glycosuria may initially need insulin, but these patients can often be switched to oral agents once their glucose levels normalize.
Two new trends have emerged as a result of the wider range of treatment options and greater recognition of the multiple defects that underlie type 2 diabetes. Metformin-which targets both insulin resistance and hepatic glucose production-has largely replaced the sulfonylureas as first-line monotherapy. And drug combinations are now used earlier. Even triple therapy-for which there are little supporting data-is now widely used, often with good results.
A new wrinkle is single-pill formulations that combine two different drugs: metformin plus glyburide (Glucovance), metformin plus glipizide (Metaglip), and metformin plus rosiglitazone (Avandamet). Combination therapy is state of the art, convenience is a plus, and it means patients buy one less pill. But each formulation is hampered by difficulties in delivering the optimal dose of both drugs.
While some recent data suggested that metformin and sulfonylureas are probably not teratogenic, the use of any oral glucose-lowering agent should still be avoided during pregnancy and breast-feeding. Women taking oral hypoglycemic agents who become pregnant should switch to insulin as soon as possible.
Washington.
COPYRIGHT 2003 International Medical News Group
COPYRIGHT 2003 Gale Group
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