| In support of an early polypharmacy approach to the treatment of type 2 diabetes. | |
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MedLine Citation:
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PMID: 20880339 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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Type 2 diabetes (T2DM) is a multifaceted disease, characterized by hyperglycaemia, resulting from a combination of insulin resistance, impaired incretin action and β-cell dysfunction leading to relative insulin deficiency. Although traditional anti-diabetes agents improve hyperglycaemia, they do so at a cost, which may entail hypoglycemia and increased body weight; exacerbating dyslipidemia, hypertension and components of insulin resistance and metabolic syndrome associated with T2DM-potentially increasing cardiovascular risk. At diagnosis, many patients with T2DM are treated with medical nutritional therapy (MNT) and exercise, then single or multiple oral anti-diabetes agents until treatment failure, when insulin is used. This strategy has been challenged by recommendations for polypharmacy approaches to the treatment of T2DM, as current strategies are unable to improve multiple aspects of the disease, nor are they likely to address underlying pathophysiology. Although the 2009 American Diabetes Association (ADA) and the European Association for the Study of Diabetes (EASD) treatment algorithm recommends a stepwise approach with MNT and metformin, later adding oral agents, incretin-based therapies or insulin, some experts have recommended a more aggressive approach. In his 2008 ADA Banting Lecture, Dr. Ralph DeFronzo recommended early treatment with metformin, TZD and exenatide at initiation of therapy. The authors' of this article recommend an aggressive early polypharmacy approach addressing underlying pathophysiology, including the incretin defect-with MNT and exercise, metformin and an incretin-based therapy and/or basal insulin if glycemic goal is not achieved within 3 months. This approach attempts to modify the disease, aiming for tight glycemic control, weight loss, reduced hypoglycemia, improvements to hypertension, dyslipidemia and insulin resistance-and improved cardiovascular outcomes. |
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Authors:
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E E Wright; A H Stonehouse; R M Cuddihy |
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Publication Detail:
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Type: Journal Article; Research Support, Non-U.S. Gov't; Review |
Journal Detail:
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Title: Diabetes, obesity & metabolism Volume: 12 ISSN: 1463-1326 ISO Abbreviation: Diabetes Obes Metab Publication Date: 2010 Nov |
Date Detail:
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Created Date: 2010-09-30 Completed Date: 2011-06-03 Revised Date: 2011-11-30 |
Medline Journal Info:
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Nlm Unique ID: 100883645 Medline TA: Diabetes Obes Metab Country: England |
Other Details:
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Languages: eng Pagination: 929-40 Citation Subset: IM |
Copyright Information:
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© 2010 Amylin Pharmaceuticals, Inc. |
Affiliation:
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Cape Fear Valley Health System, Fayetteville, NC, USA. |
Export Citation:
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APA/MLA Format Download EndNote Download BibTex |
| MeSH Terms | |
Descriptor/Qualifier:
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Diabetes Mellitus, Type 2
/
complications,
drug therapy* Diabetic Angiopathies / prevention & control* Drug Therapy, Combination Female Humans Hypoglycemic Agents / therapeutic use* Hypolipidemic Agents / therapeutic use* Incretins / therapeutic use* Insulin / therapeutic use* Male Treatment Outcome |
| Chemical | |
Reg. No./Substance:
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0/Hypoglycemic Agents; 0/Hypolipidemic Agents; 0/Incretins; 0/Insulin |
| Comments/Corrections | |
Comment In:
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Diabetes Obes Metab. 2011 May;13(5):474-5
[PMID:
22017762
]
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From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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