Beyond Metformin: Safety Considerations in the Decision-Making Process for Selecting a Second Medication for Type 2 Diabetes Management Reflections From a Diabetes Care Editors' Expert Forum

被引:39
作者
Cefalu, William T. [1 ]
Buse, John B. [2 ]
Del Prato, Stefano [3 ]
Home, Philip D. [4 ]
LeRoith, Derek [5 ]
Nauck, Michael A. [6 ]
Raz, Itamar [7 ]
Rosenstock, Julio [8 ,9 ]
Riddle, Matthew C. [10 ]
机构
[1] Louisiana State Univ, Pennington Biomed Res Ctr, Baton Rouge, LA 70808 USA
[2] Univ N Carolina, Sch Med, Chapel Hill, NC USA
[3] Univ Pisa, Sch Med, Dept Clin & Expt Med, I-56100 Pisa, Italy
[4] Newcastle Univ, Newcastle Upon Tyne NE1 7RU, Tyne & Wear, England
[5] Icahn Sch Med Mt Sinai, New York, NY 10029 USA
[6] Diabet Zentrum Bad Lauterberg, Bad Lauterberg im Harz, Germany
[7] Hadassah Hebrew Univ Hosp, Dept Internal Med, Diabet Unit, Jerusalem, Israel
[8] Dallas Diabet & Endocrine Ctr Med City, Dallas, TX USA
[9] Univ Texas SW Med Ctr Dallas, Dallas, TX 75390 USA
[10] Oregon Hlth & Sci Univ, Div Endocrinol Diabet & Clin Nutr, Portland, OR 97201 USA
关键词
DIPEPTIDYL PEPTIDASE-4 INHIBITOR; PEPTIDE-1 RECEPTOR AGONISTS; IMPROVES GLYCEMIC CONTROL; ACUTE MYOCARDIAL-INFARCTION; ORAL HYPOGLYCEMIC AGENTS; INCRETIN-BASED THERAPIES; DRUG-NAIVE PATIENTS; ACUTE-PANCREATITIS; CARDIOVASCULAR OUTCOMES; INSULIN THERAPY;
D O I
10.2337/dc14-1395
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
The trend toward personalized management of diabetes has focused attention on the differences among available pharmacological agents in terms of mechanisms of action, efficacy, and, most important, safety. Clinicians must select from these features to develop individualized therapy regimens. In June 2013, a nine-member Diabetes Care Editors' Expert Forum convened to review safety evidence for six major diabetes drug classes: insulin, sulfonylureas (SUs), thiazolidinediones (TZDs), glucagon-like peptide-1 receptor agonists, dipeptidyl peptidase-4 inhibitors, and sodium glucose cotransporter 2 inhibitors. This article, an outgrowth of the forum, summarizes well-delineated and theoretical safety concerns related to these drug classes, as well as the panelists' opinions regarding their best use in patients with type 2 diabetes. All of the options appear to have reasonably wide safety margins when used appropriately. Those about which we know the most-metformin, SUs, insulin, and perhaps now also TZDs-are efficacious in most patients and can be placed into a basic initial algorithm. However, these agents leave some clinical needs unmet. Selecting next steps is a more formidable process involving newer agents that are understood less well and for which there are unresolved questions regarding risk versus benefit in certain populations. Choosing a specific agent is not as important as implementing some form of early intervention and advancing rapidly to some form of combination therapy as needed. When all options are relatively safe given the benefits they confer, therapeutic decision making must rely on a personalized approach, taking into account patients' clinical circumstances, phenotype, pathophysiological defects, preferences, abilities, and costs.
引用
收藏
页码:2647 / 2659
页数:13
相关论文
共 143 条
[51]   EFFECTS OF HYPOGLYCEMIC AGENTS ON VASCULAR COMPLICATIONS IN PATIENTS WITH ADULT-ONSET DIABETES .3. CLINICAL IMPLICATIONS OF UGDP RESULTS [J].
GOLDNER, MG ;
KNATTERUD, GL ;
PROUT, TE .
JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION, 1971, 218 (09) :1400-+
[52]   Rationale, design, and organization of a randomized, controlled Trial Evaluating Cardiovascular Outcomes with Sitagliptin (TECOS) in patients with type 2 diabetes and established cardiovascular disease [J].
Green, Jennifer B. ;
Bethel, M. Angelyn ;
Paul, Sanjoy K. ;
Ring, Arne ;
Kaufman, Keith D. ;
Shapiro, Deborah R. ;
Califf, Robert M. ;
Holman, Rury R. .
AMERICAN HEART JOURNAL, 2013, 166 (06) :983-U83
[53]   Sulfonylureas are not associated with increased mortality in diabetics treated with thrombolysis for acute myocardial infarction [J].
Halkin, A ;
Roth, A ;
Jonas, M ;
Behar, S .
JOURNAL OF THROMBOSIS AND THROMBOLYSIS, 2001, 12 (02) :177-184
[54]   Glycemic control and treatment failure with pioglitazone versus glibenclamide in type 2 diabetes mellitus:: a 42-month, open-label, observational, primary label, care study [J].
Hanefeld, M. ;
Pfuetzner, A. ;
Forst, T. ;
Luebben, G. .
CURRENT MEDICAL RESEARCH AND OPINION, 2006, 22 (06) :1211-1215
[55]   Once-daily sitagliptin, a dipeptidyl peptidase-4 inhibitor, for the treatment of patients with type 2 diabetes [J].
Hanefeld, Markolf ;
Herman, Gary A. ;
Wu, Mei ;
Mickel, Carolyn ;
Sanchez, Matilde ;
Stein, Peter P. .
CURRENT MEDICAL RESEARCH AND OPINION, 2007, 23 (06) :1329-1339
[56]   GLP-1 and Calcitonin Concentration in Humans: Lack of Evidence of Calcitonin Release from Sequential Screening in over 5000 Subjects with Type 2 Diabetes or Nondiabetic Obese Subjects Treated with the Human GLP-1 Analog, Liraglutide [J].
Hegedus, Laszlo ;
Moses, Alan C. ;
Zdravkovic, Milan ;
Tu Le Thi ;
Daniels, Gilbert H. .
JOURNAL OF CLINICAL ENDOCRINOLOGY & METABOLISM, 2011, 96 (03) :853-860
[57]  
Henry RR, 2013, 73 SCI SESS AM DIAB
[58]  
Hirsch Irl B., 2000, Clinical Diabetes, V18, P97
[59]   Estimating the effect of sulfonylurea on HbA1c in diabetes: a systematic review and meta-analysis [J].
Hirst, J. A. ;
Farmer, A. J. ;
Dyar, A. ;
Lung, T. W. C. ;
Stevens, R. J. .
DIABETOLOGIA, 2013, 56 (05) :973-984
[60]   Addition of biphasic, prandial, or basal insulin to oral therapy in type 2 diabetes [J].
Holman, Rury R. ;
Thorne, Kerensa I. ;
Farmer, Andrew J. ;
Davies, Melanie J. ;
Keenan, Joanne F. ;
Paul, Sanjoy ;
Levy, Jonathan C. .
NEW ENGLAND JOURNAL OF MEDICINE, 2007, 357 (17) :1716-1730