View Full Version : [Endocrinology and DM] Type 2 Diabetes Management: Choosing the Best Therapies

Wed 6th January '16, 4:46pm
Source: Type 2 Diabetes Management: Choosing the Best Therapies (http://www.medscape.com/viewarticle/852217?nlid=89024_1842&src=wnl_edit_medp_wir&uac=180112PN&spon=17&impID=857264&faf=1)

An Explosion of New Diabetes Treatments

Anne L. Peters, MD: Hi. I'm Dr Anne Peters. I'm here today with Dr Ele Ferrannini, who is a professor of medicine at the University of Pisa. Today we are going to tackle the difficult question of how to synthesize all that is new in the treatment of diabetes and how to make it practicable.

Why don't you tell us what your perspective is, an overview of what we have for treating diabetes that has come up in the past few years?

Eleuterio Ferrannini, MD, PhD: I think what is really striking about diabetes is that over a relatively short period of time, a number of new drugs and approaches have become available, whereas previously, the treatment and management of diabetes was essentially in a phase of stagnation. This is in contrast to what has been seen with hypertension, where there has been a steady development of new drugs over the course of time.

The other thing that is interesting is that there are multiple targets. It's not just the glucose or the glycated hemoglobin (A1c), but it's also the weight, the prevention of hypoglycemia, and correction of the basic pathophysiologic defects in diabetes. On the one hand, this should not be too surprising because we know that diabetes is a systemic, multifactorial, and polygenic disease. It makes all the sense in the world that there should be multiple therapeutic targets.

The difficulty for physicians is that all of these approaches have become available over a relatively short period of time. Although I believe that, in the long term, it will turn out to be an advantage and an asset, it may initially be confusing because doctors may have some difficulty finding the best treatment for the individual patient with so many options open.

Dr Peters: Yes. I think another thing that makes it confusing is that not only are there all the classes of drugs, but there are different names within the classes for each agent. Then, there are all of these combinations that all have their own names. Everything varies from once a day to once a week to oral to injected. I think it's very important for practitioners to start to understand the classes themselves and then how they will mesh together.

Choosing a First and Second Agent

What is your primary goal? When you have a patient with type 2 diabetes whose A1c is 9% or 10% and he is 45 years old, what do you think of when you start therapy?

Dr Ferrannini: The first thing that I do is gather as much information about this patient as I possibly can:

How did he learn about his diabetes?

How long has he been diabetic?

Is there a family history of diabetes?

What is his blood pressure?

What is his serum lipid profile?

What is his renal function?

Is there any history of allergy or intolerance to other drugs?

What is his family situation, not just the socioeconomic level, but the family?

Refer to the source for more information

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