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TARGETING PHYSIOLOGIC ABNORMALITIES

TARGETING
PHYSIOLOGIC
ABNORMALITIES

To address the complexity of T2DM, consider an approach that targets different physiologic abnormalities

Consider combining therapeutic classes that target different physiologic abnormalities in T2DM.1-3

Tap on the drug classes alone or in combination to see how they address the complexity of T2DM.

GI TRACT
α-ISLET CELL
KIDNEY
MUSCLE
BRAIN
ADIPOSE CELL
PANCREAS
LIVER

DPP-4i=dipeptidyl-peptidase-4 inhibitor; GI=gastrointestinal; GLP-1 RA=glucagon-like peptide-1 receptor agonist; SGLT-2i=sodium-glucose co-transporter-2 inhibitor; TZD=thiazolidinedione

ADA and AACE guidelines recommend the use of combinations of oral therapies and combinations of injectable therapies that address different pathways4,5

  • Insulin is the key hormone responsible for stimulating liver, muscle, and fat to remove glucose from the blood3
  • For patients who are falling short of their HbA1c target, the use of additional therapies in combination that address different physiologic abnormalities may be appropriate6,7
  • Clinical rationale for using multiple therapies in combination may include:

    -Targeting different physiologic changes that contribute to hyperglycemia7,8

    -Tailoring treatment to better meet individual patient needs4

Guidelines by the American Diabetes Association (ADA) and the American Association of Clinical Endocrinologists (AACE) recommend healthy eating, weight control, increased physical activity, and diabetes education as a foundation for T2DM management throughout the course of treatment.4,5

Download a chart showing combinations of therapies and their effect on the physiologic abnormalities, to use in your office >

References:

1. Ferrannini E, DeFronzo RA. Impact of glucose-lowering drugs on cardiovascular disease in type 2 diabetes. Eur Heart J. 2015;36(34):2288-2296. 2. DeFronzo RA, Eldor R, Abdul-Ghani M. Pathophysiologic approach to therapy in patients with newly diagnosed type 2 diabetes. Diabetes Care. 2013;36(Suppl 2):S127-S138. 3. Aronoff, SL, Berkowitz K, Shreiner B, Want L. Glucose metabolism and regulation: beyond insulin and glucagon. Diabetes Spectrum. 2004;17(3):183-190. 4. American Diabetes Association. Standards of medical care in diabetes. Diabetes Care. 2016;39(Suppl. 1):S1–S112. 5. Garber AJ, Abrahamson MJ, Barzilay JI, et al. Consensus statement by the American Association of Clinical Endocrinologists and the American College of Endocrinology on the comprehensive type 2 diabetes management algorithm—2016 executive summary. Endocr Pract. 2016;22(1):84-113. 6. Berlie H, Hurren KM, Pinelli NR. Glucagon-like peptide-1 receptor agonists as add-on therapy to basal insulin in patients with type 2 diabetes: a systematic review. Diabetes Metab Syndr Obes. 2012;5:165-174. 7. DeFronzo RA. From the triumvirate to the ominous octet: a new paradigm for the treatment of type 2 diabetes mellitus. Diabetes. 2009;58(4):773-795. 8. Balena R, Hensley IE, Miller S, Barnett AH. Combination therapy with GLP-1 receptor agonists and basal insulin: a systematic review of the literature. Diabetes Obes Metab. 2013;15(6):485-502. doi:10.1111/dom.12025