05/20/2010 - Articles

Combination therapy in type 2 diabetes

By: Susan Aldridge, medical journalist, PhD


The American Diabetes Association recommends that people with type 2 diabetes start on metformin and lifestyle modification after diagnosis. But type 2 diabetes is a progressive disease and so a second drug may need to be added at some stage. There are a number of second drugs that might be used including sulfonylureas, insulin, thiazolidinediones like pioglitazone, and the glucagon-like peptide analog exenatide. The ideal combination is not known so researchers at the University of Connecticut have looked at the evidence on type 2 diabetes drugs.

They found 27 relevant clinical trials that covered over 11,000 patients. All of the medications were able to reduce glucose levels in type 2 diabetes, as required. What is of interest is the other effects in diabetes. Thiazolidinediones, sulfonylureas and glinides were all associated with weight gain of around two kilograms in patients with diabetes. But the glucagon-like peptides analogs and other more recent drugs were linked to either weight loss or no weight gain. And the sulfonylureas and glinides were linked to a higher risk of hypoglycaemia (low blood sugar). The researchers say that these risk factors ought to be taken into account when the doctor prescribes a second medication to go with metformin in the treatment of type 2 diabetes.



Phung O et al Effect of noninsulin antidiabetic drugs added to metformin therapy on glycemic control, weight gain, and hypoglycaemia in type 2 diabetes Journal of the American Medical Association 14th April 2010;303:1410-1418


Created on: 05/20/2010
Reviewed on: 05/20/2010

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