PMID- 27796904
OWN - NLM
STAT- PubMed-not-MEDLINE
LR  - 20201001
IS  - 1869-6953 (Print)
IS  - 1869-6961 (Electronic)
IS  - 1869-6961 (Linking)
VI  - 7
IP  - 4
DP  - 2016 Dec
TI  - Strategies for Diabetes Management: Using Newer Oral Combination Therapies Early 
      in the Disease.
PG  - 621-639
AB  - INTRODUCTION: The duration of uncontrolled type 2 diabetes mellitus (T2DM) can 
      adversely impact small and large vessels, eventually leading to microvascular and 
      macrovascular complications. Failure of therapeutic lifestyle changes, 
      monotherapy, and clinical inertia contribute to persistent hyperglycemia and 
      disease progression. The aim was to review the complex pathophysiology of type 2 
      diabetes and how different oral agents can be used effectively as first-line 
      therapy in combination with metformin, as well as in patients not achieving 
      glycemic goals with metformin therapy. METHODS: For this review, a non-systematic 
      literature search of PubMed, NCBI, and Google Scholar was conducted. RESULTS: New 
      oral agents have made it possible to improve glycemic control to near-normal 
      levels with a low risk of hypoglycemia and without weight gain, and sometimes 
      with weight loss. Early combination therapy is effective and has been shown to 
      have a favorable legacy effect. A number of agents are available in a single-pill 
      combination (SPC) that provides fewer pills and better adherence. Compared with 
      adding a sulfonylurea, still the most common oral combination used, empagliflozin 
      has been shown to decrease cardiovascular (CV) events in a dedicated CV outcome 
      study, and pioglitazone has been effective in reducing the risk of secondary CV 
      endpoints, whereas sulfonylureas have been associated with an increased risk of 
      CV disease. In those failing metformin, triple oral therapy by adding a 
      non-metformin SPC such as empagliflozin/linagliptin or pioglitazone/alogliptin is 
      a good option for reducing glycated hemoglobin (HbA1c) without significant 
      hypoglycemia. CONCLUSION: Clinicians have a comprehensive armamentarium of 
      medications to treat patients with T2DM. Clinical evidence has shown that dual or 
      triple oral combination therapy is effective for glycemic control, and early 
      treatment is effective in getting patients to goal more quickly. Use of SPCs is 
      an option for double or triple oral combination therapy and may result in better 
      adherence.
FAU - Zonszein, Joel
AU  - Zonszein J
AD  - Montefiore Medical Center, University Hospital for Albert Einstein College of 
      Medicine, Bronx, NY, USA. joel.zonszein@einstein.yu.edu.
FAU - Groop, Per-Henrik
AU  - Groop PH
AD  - Abdominal Center Nephrology, University of Helsinki and Helsinki University 
      Hospital, Helsinki, Finland.
AD  - Folkhalsan Institute of Genetics, Folkhalsan Research Center, Biomedicum 
      Helsinki, Helsinki, Finland.
AD  - Baker IDI Heart & Diabetes Institute, Melbourne, Australia.
LA  - eng
GR  - P30 DK020541/DK/NIDDK NIH HHS/United States
PT  - Journal Article
PT  - Review
DEP - 20161031
PL  - United States
TA  - Diabetes Ther
JT  - Diabetes therapy : research, treatment and education of diabetes and related 
      disorders
JID - 101539025
PMC - PMC5118246
OTO - NOTNLM
OT  - DPP-4 inhibitors
OT  - Early combination therapy
OT  - Hyperglycemia
OT  - Hypoglycemia
OT  - Oral glucose-lowering agents
OT  - SGLT2 inhibitors
OT  - Single-pill combination
OT  - Type 2 diabetes mellitus
EDAT- 2016/11/01 06:00
MHDA- 2016/11/01 06:01
PMCR- 2016/10/31
CRDT- 2016/11/01 06:00
PHST- 2016/08/19 00:00 [received]
PHST- 2016/11/01 06:00 [pubmed]
PHST- 2016/11/01 06:01 [medline]
PHST- 2016/11/01 06:00 [entrez]
PHST- 2016/10/31 00:00 [pmc-release]
AID - 10.1007/s13300-016-0208-5 [pii]
AID - 208 [pii]
AID - 10.1007/s13300-016-0208-5 [doi]
PST - ppublish
SO  - Diabetes Ther. 2016 Dec;7(4):621-639. doi: 10.1007/s13300-016-0208-5. Epub 2016 
      Oct 31.