Physicians now have an amazing array of drug therapies for control of type 2 diabetes. Until now, there has been no consensus as to which drugs to use, and when.
The American Association of Clinical Endocrinologists and the American College of Endocrinology have just issued a joint statement with specific drug recommendations. Their algorithm is quite detailed. Here are a few highlights you might not know about:
- Regular human insulin is not recommended
- NPH insulin is not recommended
- The following should be used earlier and more frequently: GLP-1 agonists (exenatide) and DPP-4 inhibitors (sitagliptin and saxagliptin)
- sulfonylureas are a lower priority
- metformin is still a key drug
In the U.S., exenatide is sold as Byetta; sitagliptin is Januvia; saxagliptin is Onglyza; metformin is Glucophage (among others).
If you have type 2 diabetes and are arguing with your physician about optimal drug therapy, this treatment algorithm may be a helpful tie-breaker.
Reference: Statement by an American Association of Clinical Endocrinologists/American College of Endocrinology consensus panel on type 2 diabetes mellitus: An algorithm for glycemic control. Endocrine Practice, 15 (2009): 540-559.
Diabetic Mediterranean Diet 
I’m a little surprised to see GLP/DPP-IV drugs being pushed earlier and earlier. While their pathway is definitely intriguing, they’re still relying solely on short term A1c data. I was under the impression that there have not yet been any studies completed looking at hard endpoints (I know Merck’s lining up to take Januvia into CV disease – they’re either brave or they have some fascinating internal data). I still marvel at the TZD story where biomarkers displaced thinking about physiological endpoints. Too much predictive biochemistry and not enough measured physiology.
Very good points, Isaac.
-Steve