Combination treatment of type 2 diabetes mellitus

Abstract

The increasing number of antidiabetic drugs decreased HbA1C levels in type 2 diabetes. Strict HbA1C control is very important to decrease the long term complications of diabetes. Although most of the oral antidiabetic drugs are adequate for glycemic control, they are not successful to control patients whose HbA1C levels are more than 7% and who have fasting hyperglycemia. The combined use of the oral drugs that affect in different ways provides additional success to lower HbA1C levels. Moreover, not only are they useful and provide additional power but also they have less side effects with lower doses. In patients whose medical treatment is unsuccessful with metformin and altered life style, adding a second oral or an injectable drug are the other therapeutic alternatives. If the HbA1C levels could not be decreased with metformin, sulfonilurea and basal insulin, intensive insulin therapy must be started. Traditional "step by step" approach may cause worse glycemic control and delay the steps of the therapy. Although hyperglycemia periods last in short periods it may increase the complications. Traditional "step by step" approach should be avoided and new therapeutic approachs should be preferred including early combined therapy. © 2012 OMU.