[Combined treatment of type 2 diabetes].
Type 2 diabetes at present represents a challenge to public health throughout the world. Its incidence is increasing in a considerable way and, therefore, cardiovascular morbi-mortality associated with macro or micro-angiopathy. The prevention of vascular complications in these patients must include control of all the cardiovascular risk factors as well as of glycemia. In recent years it has been shown that the control of the latter has to be much more strict and that in many cases monotherapy does not achieve the established aims. At the same time, new oral anti-diabetic medicines have recently appeared with different mechanisms of action. The possible combinations of treatment with different oral anti-diabetics, or else with oral anti-diabetics with insulin, are very numerous and have shown their effectiveness in reducing glycemia and the glycosylated haemoglobin. This is why the combined treatment is at present an alternative to insulinisation in monotherapy for patients with type 2 diabetes and bad control in monotherapy. In this paper the available scientific evidence on each one of the combinations and their possible indications is reviewed. Selection of the type of association necessary will depend on the individual aims of control, on the physiopathological mechanism presumably involved in each case, on the efficacy, cost and secondary effects of each medicine, as well as on the characteristics of each patient.
Menéndez
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Servicio de Endocrinología, Hospital de Navarra, Pamplona. emenendt@cfnavarra.es