Management Of Type 2 Diabetes: Selecting Amongst Available Pharmacological Agents

Abstract

In the early 1990’s, providers” choices for pharmacological management of type 2 diabetes were limited to insulin, sulfonylureas, and metformin. Since then, multiple classes of agents have been discovered, approved, and put into clinical use. Today there are 12 different classes of agents available with each class having multiple agents to choose from, raising the total number of options to an unprecedented high. While these additional choices are of significant benefit to patients, they require providers to be ever vigilant and knowledgeable about advantages and disadvantages of each medication. Therefore, diabetes management has shifted away from “one size fits all” care to an individualized approach for each patient. The goal of this chapter is to discuss an approach to pharmacological management that reviews current guidelines, discusses our local practices, and provides background information into factors that influence a provider’s choice of a particular agent. These include efficacy, cost, side effects, patient preference (maximizing adherence), durability of efficacy, and additional benefits. The last point on “additional benefits” refers to recent evidence that certain medications have been shown to confer cardiovascular and renal protection. Armed with background information into all these important factors can help practitioners guide their patients through the natural history of type 2 diabetes and add additional agents that will be of maximal benefit.