title: Add-on therapies to metformin for type 2 diabetes.
abstract: BACKGROUND
  As of 2010, approximately 285 million people worldwide have diabetes; that number is estimated to increase to 439 million by 2030. The majority of these individuals (> 90%) have type 2 diabetes, a chronic and progressive disease.
  
  
  METHODS
  Metformin monotherapy is a safe and effective option. However, its effects on glycemia are typically of limited durability. Progressive loss of β-cell function and failure of metformin monotherapy to control glucose adequately prompt the addition of other oral antidiabetic drugs, such as sulfonylureas and thiazolidinediones, which have their own limitations. Evidence suggests that incretin-based agents can successfully achieve glycemic control while potentially providing cardiovascular and β-cell-function benefits.
  
  
  RESULTS
  Knowledge of the available clinical evidence on the incretin-based therapies and other pharmacotherapeutic options for patients with type 2 diabetes who fail first-line therapy with metformin, through an analysis of improved glycemic parameters and overall risk:benefit profiles.
  
  
  CONCLUSIONS
  Traditional oral antidiabetic agents, recommended as first- and second-line therapies in patients with type 2 diabetes inadequately controlled with diet/exercise or monotherapy, have limited durability of effect and are associated with an increased risk of adverse events. Glucagon-like peptide-1 receptor agonists and dipeptidyl peptidase-4 inhibitors provide glycemic control and are promising additions to the pharmacotherapeutic armamentarium.
authors.affiliation: Union Memorial Hospital, The Diabetes & Endocrine Center, 201 E. University Parkway, 33rd Street Professional Building, Suite 501, Baltimore, MD 21218, USA. mansur.shomali@medstar.net
authors.forename: Mansur
authors.initials: M
authors.lastname: Shomali
mesh_terms: D003924:Diabetes Mellitus, Type 2 / Q000188:drug therapy* / Q000378:metabolism; D054873:Dipeptidyl-Peptidase IV Inhibitors / Q000627:therapeutic use; D018450:Disease Progression; D004359:Drug Therapy, Combination; D052216:Glucagon-Like Peptide 1 / Q000819:agonists; D006801:Humans; D007004:Hypoglycemic Agents / Q000493:pharmacokinetics / Q000627:therapeutic use*; D054795:Incretins / Q000627:therapeutic use; D007328:Insulin / Q000627:therapeutic use; D008019:Life Style; D008687:Metformin / Q000493:pharmacokinetics / Q000627:therapeutic use*; D017211:Treatment Failure
chemical_list: D054873:Dipeptidyl-Peptidase IV Inhibitors; D007004:Hypoglycemic Agents; D054795:Incretins; D007328:Insulin; D052216:Glucagon-Like Peptide 1; D008687:Metformin