PMID- 25770115
OWN - NLM
STAT- MEDLINE
DCOM- 20151103
LR  - 20221207
IS  - 1542-6270 (Electronic)
IS  - 1060-0280 (Linking)
VI  - 49
IP  - 6
DP  - 2015 Jun
TI  - Combination therapy when metformin is not an option for type 2 diabetes.
PG  - 688-99
LID - 10.1177/1060028015572653 [doi]
AB  - OBJECTIVE: Consensus on combination options for patients with type 2 diabetes 
      mellitus (T2DM) unable to use metformin is lacking. This review summarizes data 
      describing-non-metformin based combination therapy. DATA SOURCES: PubMed searches 
      (January 1990 to August 2014) were conducted with terms for newer drug therapies 
      alone and with the term combination; filters were applied for Clinical Trial, 
      Meta Analysis, and English language. STUDY SELECTION AND DATA EXTRACTION: Results 
      were reviewed for multicenter, randomized controlled trials of 
      non-metformin-based combination therapy conducted in the past 5 years and 
      specific to the US or multinational populations. DATA SYNTHESIS: Although 
      multiple injectable and oral agents have been studied in combination with 
      metformin for management of T2DM, data are more limited for combinations without 
      metformin. Combinations of incretins (injectable glucagon-like peptide-1 receptor 
      agonists or oral dipeptidyl peptidase-4 [DPP-4] inhibitors) with a sulfonylurea, 
      thiazolidinedione, or insulin are well studied and provide greater 
      glucose-lowering efficacy than monotherapy. Incretins are associated with a low 
      risk of hypoglycemia when used as monotherapy; the dosage of sulfonylurea or 
      insulin should be reduced when used in combination. Newer studies are 
      investigating the combined use of an oral sodium-glucose cotransporter 2 
      inhibitor and a DPP-4 inhibitor. In a recent study, reductions in glycated 
      hemoglobin (A1C) of 1.1% to 1.2% and reduced weight with no additive risk of 
      hypoglycemia were observed. CONCLUSIONS: Selecting the most appropriate 
      combination therapy for patients with T2DM requires balancing clinical benefits 
      with the risks, such as weight gain and hypoglycemia. Treatment approaches should 
      be individualized for vulnerable patient populations for whom metformin is not 
      appropriate.
CI  - (c) The Author(s) 2015.
FAU - Goldman-Levine, Jennifer D
AU  - Goldman-Levine JD
AD  - MCPHS University, Boston, MA, USA jennifer.goldman-levine@mcphs.edu.
LA  - eng
PT  - Journal Article
PT  - Research Support, Non-U.S. Gov't
PT  - Review
DEP - 20150313
PL  - United States
TA  - Ann Pharmacother
JT  - The Annals of pharmacotherapy
JID - 9203131
RN  - 0 (Blood Glucose)
RN  - 0 (Glycated Hemoglobin A)
RN  - 0 (Hypoglycemic Agents)
RN  - 9100L32L2N (Metformin)
SB  - IM
MH  - Blood Glucose/*drug effects
MH  - Diabetes Mellitus, Type 2/*drug therapy
MH  - Drug Therapy, Combination
MH  - Glycated Hemoglobin/analysis
MH  - Humans
MH  - Hypoglycemia/chemically induced
MH  - Hypoglycemic Agents/administration & dosage/*therapeutic use
MH  - Metformin/therapeutic use
OTO - NOTNLM
OT  - antidiabetic drug
OT  - combination therapy
OT  - type 2 diabetes
EDAT- 2015/03/15 06:00
MHDA- 2015/11/04 06:00
CRDT- 2015/03/15 06:00
PHST- 2015/03/15 06:00 [entrez]
PHST- 2015/03/15 06:00 [pubmed]
PHST- 2015/11/04 06:00 [medline]
AID - 1060028015572653 [pii]
AID - 10.1177/1060028015572653 [doi]
PST - ppublish
SO  - Ann Pharmacother. 2015 Jun;49(6):688-99. doi: 10.1177/1060028015572653. Epub 2015 
      Mar 13.