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Intensifying Treatment Beyond Monotherapy in Type 2 Diabetes Mellitus: Where Do Newer Therapies Fit?

  • Diabetes and Cardiovascular Disease (SR Wright, Section Editor)
  • Published:
Current Cardiology Reports Aims and scope Submit manuscript

Abstract

Purpose of Review

Guidelines for a standard second diabetes medication for the treatment of type 2 diabetes (T2DM) have yet to be established. The rapid increase in the number of newer therapies available makes the choice more difficult. Thus, we reviewed clinical trial evidence evaluating newer therapies available for treatment intensification beyond monotherapy.

Recent Findings

Head-to-head studies comparing newer therapies versus traditional (i.e., sulfonylurea) approaches consistently find lower incidence of hypoglycemia and weight gain with newer therapies. Glucagon-like peptide-1 (GLP-1) receptor agonists and sodium-glucose co-transporter 2 (SGLT2) inhibitors demonstrate high glycemic efficacy, while merits of dipeptidyl peptidase-4 (DPP-4) inhibitors include their tolerability. Secondary effects (weight loss, cardiovascular outcomes, renal function) are of growing interest with newer therapies.

Summary

Choices for treatment intensification in T2DM diabetes are numerous. Understanding the comparative evidence of newer treatment choices, as provided in this review, may help guide clinical decision making.

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Acknowledgments

The authors would like to thank Sameer Desale, MS, MedStar Health Research Institute, for assistance in creating Fig. 1.

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Authors and Affiliations

  1. MedStar Health Research Institute, 6525 Belcrest Road, Suite #700, Hyattsville, MD, 20782, USA

    Alexander Kuhn, Jean Park, Adline Ghazi & Vanita R. Aroda

  2. Georgetown University School of Medicine, Washington, DC, USA

    Vanita R. Aroda

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  1. Alexander Kuhn
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  2. Jean Park
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  3. Adline Ghazi
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Correspondence to Vanita R. Aroda.

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Alexander Kuhn declares no conflict of interest.

Jean Park has served as an investigator on clinical trials (Janssen) through her employer.

Adline Ghazi declares no conflict of interest.

Vanita R. Aroda has served as an investigator on clinical trials (Astra Zeneca/BMS, Calibra, Eisai, Elcelyx, Janssen, Novo Nordisk, Sanofi, Theracos) and has served as a consultant (Adocia, Astra Zeneca, Janssen, Medscape, Novo Nordisk, Sanofi), all activities through her employer.

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This article does not contain any studies with human or animal subjects performed by any of the authors.

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This article is part of the Topical Collection on Diabetes and Cardiovascular Disease

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Kuhn, A., Park, J., Ghazi, A. et al. Intensifying Treatment Beyond Monotherapy in Type 2 Diabetes Mellitus: Where Do Newer Therapies Fit?. Curr Cardiol Rep 19, 25 (2017). https://doi.org/10.1007/s11886-017-0832-3

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