Recent and Trending Patient-Centered Type 2 Diabetes Treatments

New Orleans—Many new type 2 diabetes and type 2 diabetes-related treatments are taking patient-centered approaches. The American Diabetes Association and the European Association for the Study of Diabetes advocate personalized treatment. Patient-centered type 2 diabetes and type 2 diabetes-related treatments were created to intensify therapy and customize drug treatment to better address an individual patient’s needs.

Edward Shahady, MD, editorial board member, Consultant, clinical professor of family medicine, University of Miami, University of Florida, and Daniel Einhorn, MD, FACP, FACE, president, American College of Endocrinology, presented emerging patient-centered type 2 diabetes and type 2 diabetes-related therapies and current trends during a session at the CRS meeting.

Specializing treatment for type 2 diabetes patients is essential when comorbidities are present. For example, hyperglycemia is a comorbidity of type 2 diabetes that has been assessed for treatment optimization. A study by Inzucchi and colleagues evaluated five 2-drug combination therapies for type 2 diabetes patients with hyperglycemia in order to generate an effective patient-centered treatment.
Researchers supplemented metformin with 5 drugs used to treat type 2 diabetes: (1) sulfonylurea;
(2) thiazolidinedione; (3) dipeptidyl peptidase-4 (DPP-4) inhibitor; (4) glucagon-like peptide-1 (GLP-1) receptor agonist; and (5) insulin.

Traditionally, metformin is used as the initial monotherapy for type 2 diabetes patients with hyperglycemia. During the course of the study, metformin alone demonstrated high efficacy, low risk of hypoglycemia, and low costs. Side effects noted included gastrointestinal/lactic acidosis [Diabetes Care. 2012;35(6):1364-1379].

Sulfonylurea in combination with metformin showed a high efficacy; a moderate risk of hypoglycemia, which is also the 2-drug combination’s major side effect; and a low cost.

According to the study, thiazolidinedione supplemented with metformin exhibited a high efficacy, a low risk of hypoglycemia, and high costs. This drug combination showed 3 major side effects: (1) edema; (2) heart failure; and (3) bone fractures.

When a DPP-4 inhibitor was used in combination with metformin, efficacy was intermediate, there was a low risk of hypoglycemia, and costs of the 2-drug therapy were high. Side effects of the drug combination were rare.

A GLP-1 receptor supplemented with metformin exhibited high efficacy, a low risk of hypoglycemia, and high cost. The primary side effect of a GLP-1 receptor combined with metformin was gastrointestinal in nature.  

When insulin was combined with metformin, efficacy was the most pronounced of all drug combinations included in the study. However, this drug combination also exhibited the highest risk of hypoglycemia, making it the top side effect, and costs were considered variable, according to the study.

Metformin is the optimal first-line drug for treatment of type 2 diabetes, according to the findings. Adopting a 2-drug combination therapy should be considered to optimize treatment for individual patients. Ultimately, all treatment decisions should be patient-centric, focusing on their individualized wants, needs, and preferences, according to the presentation.—Melissa Cooper