The key to effective diabetes management lies in choosing the right combination of medicines, taking into account the course of the disease in each patient.
Most patients with type 2 diabetes are able to successfully control blood glucose levels using anti-diabetic drugs and lifestyle modifications. However, other patients need to combine these medications with injectable forms to maintain normal sugar.
For many years, the only injectable drug for diabetes was insulin. Now there are other approved drugs that can be injected. Thus, by combining different means, endocrinologists for each type 2 diabetes may choose an individual treatment regimen.
Type 2 diabetes is a chronic disease that will accompany the patient all his life, so the doctor's job is to choose the most simple treatment for a person.
One of the most important factors is the patient's attitude to injections: not every person can easily transfer his injections. The second principle of combination therapy of type 2 diabetes is the choice of drugs that enhance the effect of each other. A proper combination of drugs can be very effective.
One of the most commonly used drugs for intravenous diabetes mellitus is metformin, which is sold under various trade names. This medicine works by reducing the amount of glucose produced by the liver. Metformin can be combined with insulin or glucagon-like peptide-1 (GPP-1) agonists that stimulate insulin production.
In addition, endocrinologists use a combination of insulin with PPP-1 agonists and preparations of thiazolidinediones, which increases the sensitivity of tissues to insulin. Physicians recommend using one of two new GPP-1 agonists for those patients who are normally pricked.
Alternatives to dipeptidyl peptidase-4 (PPP-4) inhibitors are for patients who do not want to use injectable drugs. They can be taken as tablets. Both classes of drugs (AGP-1 agonists and PPP-4 inhibitors) work in the same way and are considered to be equivalent. They improve blood sugar control by increasing insulin release, leading to a decrease in glucose concentration in the blood.
In the appointment of combined treatment, the most important point is minimizing the risk of side effects. Some antidiabetic medicines may cause very high levels of glucose, i.e. hypoglycaemia.
Medicines from the sulfonylureas group, which have long been used in type 2 diabetes, have a moderate ability to cause hypoglycemia. Therefore, many doctors prefer to appoint metformin instead of them, the hypoglycemic effect of which is expressed much less.
When choosing a combination therapy it is also important to remember the weight of the patient's body. Many types of type 2 diabetes have overweight or obesity, which worsens glycemic control. Some medications for ingestion cause an increase in body weight. Insulin also promotes weight gain.
Therefore, the first-line drug is metformin, which in patients with overweight is often combined with PPP-1 agonists. Medicines of this group suppress appetite and increase the sensation of saturation. This helps to slightly reduce the body weight of 30% of patients.
Almost all drugs have these or other side effects. In a small number of patients metformin can cause nausea, abdominal pain and diarrhea. AGP-1 agonists also have some negative effects on the gastrointestinal tract. Therefore, sometimes patients with diabetes refuse to receive them. However, most still try to adhere to the treatment scheme, since the positive effects outweigh the negative.