Step-by-step Individual Intensification of Therapy for Type 2 Diabetes Mellitus. What is Further Choice after Metformin? (Literature Review)

• Main Author: І.V. Pankiv
• Format: Article
• Language: English
• Published: Publishing House Zaslavsky 2015-03-01
• Series: Mìžnarodnij Endokrinologìčnij Žurnal
• Subjects: type 2 diabetes mellitus; metformin; combined treatment
• Online Access: http://iej.zaslavsky.com.ua/article/view/75447

Metformin — first-line drug for the treatment of diabetes mellitus (DM) type 2, the use of which reduces the progression of carbohydrate metabolism disorders and helps to reduce mortality rates. The progressive course of DM type 2 leads to the fact that patients, in which initial therapy contained only metformin, ultimately required step-by-step addition of other glucose-lowering drugs to achieve and maintain glycemic control. This literature review examines different approaches to step-by-step individual intensification of therapy for DM type 2. The most popular and most studied combination aimed at both defects determining the development of metabolic disorders in DM type 2 (relative insulin deficiency and insulin resistance) is a combination of metformin with sulfonylurea agents. Glimepiride has a unique combination of insulin secretagogue («careful» stimulation) and insulin sensitizing properties at neutral effect on body weight and lower the risk of hypoglycemia. Therefore, glimepiride today is regarded as the best choice in patients with DM type 2 in the presence of cardiovascular risk compared with other sulfonylurea drugs.