Selecting among ADA/EASD tier 1 and tier 2 treatment options.
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.
McGill
Janet B
JB
Department of Medicine, Division of Endocrinology, Metabolism and Lipid Research, Washington University School of Medicine, St. Louis, MO, USA.
D000284:Administration, Oral; D001786:Blood Glucose / Q000187:drug effects / Q000378:metabolism; D003924:Diabetes Mellitus, Type 2 / Q000175:diagnosis / Q000188:drug therapy*; D004305:Dose-Response Relationship, Drug; D004334:Drug Administration Schedule; D004359:Drug Therapy, Combination; D005260:Female; D005905:Glyburide / Q000008:administration & dosage; D006801:Humans; D006943:Hyperglycemia / Q000517:prevention & control; D007003:Hypoglycemia / Q000517:prevention & control; D007004:Hypoglycemic Agents / Q000008:administration & dosage* / Q000009:adverse effects; D008297:Male; D008687:Metformin / Q000008:administration & dosage; D017410:Practice Guidelines as Topic; D011379:Prognosis; D018570:Risk Assessment; D000077154:Rosiglitazone; D012720:Severity of Illness Index; D045162:Thiazolidinediones / Q000008:administration & dosage; D016896:Treatment Outcome
D001786:Blood Glucose; D007004:Hypoglycemic Agents; D045162:Thiazolidinediones; D000077154:Rosiglitazone; D008687:Metformin; D005905:Glyburide