Selecting among ADA/EASD tier 1 and tier 2 treatment options.

Abstract

Each of the 4 groups of medications considered preferred therapies for treatment of T2DM by the ADA/EASD panel--insulin, sulfonylureas, TZDs, and incretin-based therapies (GLP-1 receptor agonists)--possesses significant advantages and disadvantages to be considered when individualizing treatment. Insulin and the sulfonylureas are the most researched therapies available, as well as the most cost-effective and the most effective in achieving glycemic goals. The TZDs have been shown to improve various markers of pancreatic beta-cell function; however, there is a risk of edema and heart failure with the TZDs; rosiglitazone has been associated with an increase in cardiovascular events. GLP-1 receptor agonists and DPP-4 inhibitors address different pathophysiologic causes than do other diabetes medications and offer the benefit of a low incidence of hypoglycemia. Moreover, GLP-1 receptor agonists promote weight loss, whereas DPP-4 inhibitors are generally weight neutral.

• Authors: Janet B McGill
• Journal: The Journal of family practice (J Fam Pract) Vol. 58 Issue 9 Suppl Treating Pg. S26-34 (Sep 2009) ISSN: 1533-7294 [Electronic] United States
• PMID: 19744422 (Publication Type: Journal Article, Review)

Chemical References

• Blood Glucose
• Hypoglycemic Agents
• Thiazolidinediones
• Rosiglitazone
• Metformin
• Glyburide

Topics

• Administration, Oral
• Blood Glucose (drug effects, metabolism)
• Diabetes Mellitus, Type 2 (diagnosis, drug therapy)
• Dose-Response Relationship, Drug
• Drug Administration Schedule
• Drug Therapy, Combination
• Female
• Glyburide (administration & dosage)
• Humans
• Hyperglycemia (prevention & control)
• Hypoglycemia (prevention & control)
• Hypoglycemic Agents (administration & dosage, adverse effects)
• Male
• Metformin (administration & dosage)
• Practice Guidelines as Topic
• Prognosis
• Risk Assessment
• Rosiglitazone
• Severity of Illness Index
• Thiazolidinediones (administration & dosage)
• Treatment Outcome