Treatment approach involving multiple methods for managing type 2 diabetes
Combination therapy for type 2 diabetes involves the use of two or more medications to effectively manage high blood glucose levels. This approach is often considered when a patient's diabetes remains uncontrolled despite treatment with metformin or another medication.
Improved Glycemic Control and Beyond
Common medications used in combination therapy include GLP-1 receptor agonists (GLP-1 RAs), SGLT2 inhibitors, thiazolidinediones (TZDs), and sulfonylureas.
GLP-1 RAs, such as exenatide, improve glycemic control by enhancing insulin secretion and reducing glucagon release. They also promote weight loss and offer cardiovascular benefits with a low risk of hypoglycemia. Notably, they mimic the action of endogenous GLP-1 and can help preserve beta-cell function. Nausea is a common but usually mild side effect.
SGLT2 inhibitors, like empagliflozin, reduce blood glucose by blocking the kidneys from reabsorbing glucose into the bloodstream, instead releasing glucose in the urine. This mechanism leads to weight loss, reduced blood pressure, and benefits for heart, kidney, and heart failure outcomes. They also reduce cardiovascular risk and mortality in those with established cardiovascular disease.
TZDs, such as pioglitazone, make the body more sensitive to insulin, helping lower blood sugar levels and reducing the amount of glucose that the liver releases into the bloodstream. When combined with SGLT2 inhibitors, they may offer complementary benefits in selected patients.
Sulfonylureas, which increase insulin secretion from pancreatic beta cells, are effective at lowering blood glucose but carry a higher risk of hypoglycemia and weight gain compared to GLP-1 RAs or SGLT2 inhibitors.
Tailored Treatment for Individual Needs
The choice of medication for combination therapy will vary by individual, depending on their health needs. Doctors consider factors such as the person's health conditions, history of hypoglycemia, treatment priorities and goals, risk of side effects, and treatment cost.
People with type 2 diabetes who are at higher risk of experiencing diabetes-related complications, such as coronary artery disease, chronic kidney disease, heart failure, and liver disease, may receive combination therapy even if their blood glucose levels are within target range.
Combination therapy can help maintain blood glucose levels within target range, reducing a person's risk of experiencing complications from type 2 diabetes. Some types of combination therapy also offer benefits for weight loss, heart health, or kidney health.
For instance, combination therapy with GLP-1 RAs and SGLT2 inhibitors may offer additional benefits such as supporting weight loss, preventing heart disease, reducing blood pressure, improving outcomes in those with heart disease, kidney disease, and heart failure, and potentially reducing the risk of death in people at high risk or those with established cardiovascular disease.
Seeking Professional Guidance
It is essential for a person to seek guidance from a doctor if they do not understand why they are receiving a specific therapy or if they have any other questions about their treatment plan. The American Diabetes Association (ADA) recommends combination therapy with a GLP-1 RA and/or SGLT2 inhibitor for people with conditions that require organ protection.
In some cases, the ADA considers starting insulin in people with type 2 diabetes if they have A1C levels greater than 10% or blood glucose levels 300 milligrams per deciliter or higher, have symptoms of hyperglycemia, or experience unexplained weight loss.
In summary, the advantages of these medications in combination therapy for type 2 diabetes include improved glycemic control, weight management, cardiovascular and renal protection, and preservation of beta-cell function, with varying risks of side effects depending on the drug class. Always consult with a healthcare professional for personalised treatment advice.
- Combination therapy for type 2 diabetes, which uses multiple medications, is often employed when treating diabetes remains uncontrolled despite using metformin or another medication.
- GLP-1 receptor agonists (GLP-1 RAs), such as exenatide, are used in combination therapy to improve glycemic control, promote weight loss, and offer cardiovascular benefits with low hypoglycemia risk.
- SGLT2 inhibitors, like empagliflozin, help reduce blood glucose, promote weight loss, and offer benefits for heart, kidney, and heart failure outcomes when used in combination therapy.
- TZDs, such as pioglitazone, offer complementary benefits when used in combination with SGLT2 inhibitors in selected patients by making the body more sensitive to insulin and reducing liver glucose release.
- Sulfonylureas, while effective at lowering blood glucose, can lead to higher risks of hypoglycemia and weight gain when compared to GLP-1 RAs or SGLT2 inhibitors.
- The choice of medication for combination therapy depends on the individual's health needs, conditions, history of hypoglycemia, treatment priorities, risk of side effects, and treatment cost.
- People with type 2 diabetes at risk of complications such as coronary artery disease, chronic kidney disease, heart failure, or liver disease may receive combination therapy despite having blood glucose levels within target range.
- The American Diabetes Association (ADA) recommends considering combination therapy with a GLP-1 RA and/or SGLT2 inhibitor for people with conditions that require organ protection. Always consult with healthcare professionals for personalized treatment advice.
