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- November 20, 2008 |
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"The Value of Combination Therapy in Type 2 Diabetes"Prof. Bernard Zinman (biography)
English - 2003-10-18 - 31 minutes
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 | (28 slides) |
Summary :
The pathophysiology of type 2 diabetes is complex. In addition to insulin resistance and beta cell dysfunction, there is increased hepatic glucose production, and also adipocytokines that affect beta cell function and insulin action. It therefore makes sense to target more than one aspect of pathophysiology in the management of type 2 diabetes.
The UKPDS showed the inability of monotherapy to maintain normal glycemia(1), and the conventional stepwise approach to diabetes management may not be suitable for patients having a high HbA1c at diagnosis, for example 9%, who would require a more aggressive approach. Combination therapy should therefore target different aspects of pathophysiology to achieve a more robust effect.
As insulin resistance is an important part of the pathophysiology of type 2 diabetes, insulin sensitizers may be considered as a base for combination therapy. Thiazolidinediones make insulin resistance go down, and preserve beta cell function(2). Avandamet is a combination of rosiglitazone and metformin, and therefore targets two components of pathophysiology by improving insulin sensitivity and decreasing hepatic glucose output.
Copyright © 2003 E-MedHosting.com Inc
Learning objectives :
The participant will learn about the rationale behind using combination therapy early in type 2 diabetes treatment, and about the characteristics of Avandamet, a combination of rosiglitazone and metformin:
-Targets pathophysiology at two complimentary pathways: improved insulin sensitivity and reduced hepatic glucose output
-Robust effect on lowering HbA1c
-Low incidence of hypoglycemia
-Less weight gain
-Well tolerated
-Potential added value on beta cell function and cardiovascular risk
Bibliographic references :
1. Intensive blood-glucose control with sulphonylureas or insulin compared with conventional treatment and risk of complications in patients with type 2 diabetes (UKPDS 33) ". UK Prospective Diabetes Study (UKPDS) Group." Lancet. 1998; 352(9131):837-53.
2. Buchanan TA, Xiang AH, Peters RK, Kjos SL, Marroquin A, Goico J, Ochoa C, Tan S, Berkowitz K, Hodis HN, Azen SP. Preservation of pancreatic beta-cell function and prevention of type 2 diabetes by pharmacological treatment of insulin resistance in high-risk hispanic women. "" Diabetes. 2002 Sep;51(9):2796-803.
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