Which Drug Is Best for Treatment of Type 2 Diabetes?

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. 

Steve Parker, M.D.

Reference:  Statement by an American Association of Clinical Endocrinologists/American College of Endocrinology consensus panel on type 2 diabetes mellitus: An algorithm for glycemic controlEndocrine Practice, 15 (2009): 540-559.

2 Comments

Filed under Drugs for Diabetes

2 responses to “Which Drug Is Best for Treatment of Type 2 Diabetes?

  1. 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.

  2. Very good points, Isaac.

    -Steve