Treatment of Type 2 Diabetes With Combined Therapy

Abstract

Type 2 diabetes is a progressive syndrome that evolves toward complete insulin deficiency during the patient's life. A stepwise approach for its treatment should be tailored according to the natural course of the disease, including adding insulin when hypoglycemic oral agent failure occurs. Treatment with insulin alone should eventually be considered in a relevant number of cases. Experience has shown the protective effects of insulin on ␤-cell survival and function, resulting in more stable metabolic control. On the contrary, treatment with most insulin secretagogues has been associated with increased ␤-cell apoptosis, reduced responsiveness to high glucose, and impairment of myocardial function during ischemic conditions. In addition, macrovascular complications are associated with postprandial hyperglycemia, indicating the need for tight glycemic control. Insulin treatment, especially with rapid-acting analogs, has been demonstrated to successfully control postprandial glucose excursions. Finally, a reason for concern with regard to combined therapy is represented by the evidence that polipharmacy reduces compliance to the treatment regimen. This can be particularly relevant in patients with type 2 diabetes usually taking drugs for complications and for concomitant diseases with consequent deterioration not only of metabolic control but also of other conditions. In conclusion, therapy with insulin alone immediately after hypoglycemic oral agent failure may be a useful and safe therapeutic approach in type 2 diabetes.Diabetes Care 31 (Suppl. 2):S131-S135, 2008

Dual effects of sodium tungstate on adipocyte biology: inhibition of adipogenesis and stimulation of cellular oxygen consumption

“…Both insulin and rosiglitazone, commonly used for the treatment of type 2 diabetes in different degrees, increase adipose mass in vivo and adipocyte differentiation in vitro. 24,25 The fact that tungstate counteracts these effects could be seen as a potential mechanism to moderate these side effects. Furthermore, taking into account the antidiabetic effects of sodium tungstate enhancing insulin sensitivity in the liver and muscle, 3,4,26 it is tempting to speculate a favorable interaction with either insulin or rosiglitazone treatment in vivo.…”

Antiobesity and Hypoglycaemic Effects of Aqueous Extract of Ibervillea sonorae in Mice Fed a High‐Fat Diet with Fructose

“…All of these factors may contribute to metabolic syndrome [1]. It is estimated that genetic factors, high-fat diets, and sedentary lifestyles are the main factors underlying the development of these diseases [2, 3]. In Mexico, as in other countries, a rise in the number of obesity cases in adults and children has been noted [4–6].…”

Anti-Hyperglycemic Effect of <b><i>Vaccinium arctostaphylos </i></b>in Type 2 Diabetic Patients: A Randomized Controlled Trial

“…T2DM is characterized by a progressive decline of β-cell function up to its exhaustion, so that an adequate glycemic control with a logical combination of oral therapies cannot be achieved, which leads to the need of insulin as sole therapy. Up to 50% of patients initially treated with oral anti-hyperglycemics ultimately need insulin [3]. Conventional anti-hyperglycemic drugs have limited efficacies and significant adverse effects.…”