J Korean Med Assoc.  2014 May;57(5):435-443. 10.5124/jkma.2014.57.5.435.

Antihyperglycemic agent combination therapy for patients with type 2 diabetes mellitus

• Lee JM

• KMID: 2194887
• DOI: http://doi.org/10.5124/jkma.2014.57.5.435

Abstract

Type 2 diabetes mellitus and diabetic complications have sharply increased and have become an important issue to resolve. The goal of treatment of type 2 diabetes is to prevent the development and progress of diabetic complications by successful glycemic control. Various treatment modalities are used in the glycemic control of diabetic patients, such as lifestyle modification, oral hypoglycemic agent, insulin, insulin analogues, and GLP-1 agonist. Although there are many treatment guidelines for glycemic control, the key to successful therapy for type 2 diabetes is precise insight on the nature of the disease, characteristics of the patient, and knowledge of the therapy. Therefore, it is important to learn about antihyperglycemic drug therapy. Sulfonylurea, metformin, alpha-glucosidase inhibitor, glinide, thiazolidinedione, and SGLT2 inhibitor are used in monotherapy for the glycemic control of diabetic patients. However, the failure rate of monotherapy is not low at the beginning or during the course of treatment. When monotherapy fails, the next step is combination therapy. A well-chosen combination treatment method will help to achieve the glycemic goal before the use of insulin. In conclusion, it is essential to achieve a precise insight into the characteristics of the drug, considerations in drug choice, and the advantages/disadvantages of combination therapy. The most important thing is the appropriate individualization of the treatment after understanding the current state of diabetic patients, such as diabetic complications, age, lifestyle, body weight, hypoglycemia risk, and economic state.

Keyword

Type 2 diabetes mellitus; Hypoglycemic agents; Drug combinations

MeSH Terms

alpha-Glucosidases
Body Weight
Diabetes Complications
Diabetes Mellitus, Type 2*
Drug Combinations
Drug Therapy
Glucagon-Like Peptide 1
Humans
Hypoglycemia
Hypoglycemic Agents
Insulin
Life Style
Metformin
Drug Combinations
Glucagon-Like Peptide 1
Hypoglycemic Agents
Insulin
Metformin
alpha-Glucosidases

Figure

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  Figure 1 Treatment algorithms for glycemic control of type 2 diabetes mellitus. MET, metformin; SU, sulfonylure; DPP4i, dipepidyl peptidase inhibitor; AGi, alpha glucosidase inhibitor; TZD, thiazolidinedion; Glin, glinide; OHA, oral hypoglycemic agent; AACE/ACE, American Association of Clinical Endocrinologists/American College of Endocrinology; Tx, treatment. From Korean Diabetes Association. Treatment guideline for diabetes 2013 update. 1st ed. Seoul: Designleader Publishig; 2013 [9].

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