Use of oral combination therapy for type 2 diabetes in primary care: Meeting individualized patient goals

Lavernia, Frank; Adkins, Sarah E; Shubrook, Jay H.

doi:10.1080/00325481.2015.1085293

Cited by 39 publications

(36 citation statements)

References 86 publications

(130 reference statements)

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“…This may be a particular issue for newly diagnosed individuals who tend to be generally uncomfortable with self‐administration of antihyperglycaemic medication, but are suddenly required to become proficient in the use of several drugs at once. It is possible, however, with advances in treatments and technology, that this effect can be reduced by the use of FDCs and FRCs, as discussed in the next sections. Treatments of this nature would allow patients to receive the benefits of combination therapy while reducing the number of doses required and treatment complexity, potentially removing one of the main disadvantages of this approach.…”

Section: Combination Therapymentioning

confidence: 99%

“…Many glucose‐lowering agents are now available as single‐pill combinations or FDCs for oral combination therapy. These include formulations of metformin with DPP‐4 and SGLT2 inhibitors, and non‐metformin FDCs, such as combinations of a DDP‐4 with a SGLT2 or TZD . FDCs may provide several advantages that make them a good option for use in combination therapy; these include reducing the complexity of the dosing regimen, and improving patient adherence by reducing pill burden and dosing frequency .…”

Section: Combination Therapymentioning

confidence: 99%

“…These include formulations of metformin with DPP‐4 and SGLT2 inhibitors, and non‐metformin FDCs, such as combinations of a DDP‐4 with a SGLT2 or TZD . FDCs may provide several advantages that make them a good option for use in combination therapy; these include reducing the complexity of the dosing regimen, and improving patient adherence by reducing pill burden and dosing frequency . As FDCs are also available in a number of dosage combinations, they still provide physicians with options for dose adjustments and titration …”

Section: Combination Therapymentioning

confidence: 99%

“…In addition to the benefit of simplifying the treatment regimen, FDCs combining 2 agents at lower doses may also provide improved tolerability and greater efficacy compared with high‐ or maximal‐dose monotherapy, or co‐administered combination therapy . Collectively, this may help prescribers to overcome clinical inertia, particularly in patients who are more likely to experience delays in their treatment intensification, such as patients who are less able to adhere to complex treatment regimens (i.e.…”

Section: Combination Therapymentioning

confidence: 99%

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Initiating therapy in patients newly diagnosed with type 2 diabetes: Combination therapy vs a stepwise approach

Cersósimo

Johnson

Chovanes³

et al. 2017

Diabetes Obesity Metabolism

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There is clear evidence that achieving glycaemic targets reduces the risk of developing complications as a result of type 2 diabetes (T2D). Many patients, however, continue to have suboptimal glycaemic control because of issues that include unclear advice on how to achieve these targets as well as clinical inertia. The two management approaches recommended for patients newly diagnosed with T2D are stepwise and combination therapy, each of which has advantages and disadvantages. Stepwise therapy may result in good patient adherence and allow greater individualization of therapy, and minimization of side effects and cost, and so may be appropriate for patients who are closer to goal. Stepwise therapy, however, may also lead to frequent delays in achieving glycaemic goals and longer exposure to hyperglycaemia. Combination therapy, which is now emerging as an important therapy option, has a number of potential advantages over stepwise therapy, including reduction in clinical inertia and earlier and more frequent achievement of glycated haemoglobin goals by targeting multiple pathogenic mechanisms simultaneously, which may more effectively delay disease progression. Compared with stepwise therapy, the disadvantages of combination therapy include reduced patient adherence resulting from complex, multi-drug regimens, difficulty determining the cause of poor efficacy and/or side effects, patient refusal to accept disease, and higher cost. Fixed-dose and fixed-ratio combinations are novel therapeutic approaches which may help address several issues of treatment complexity and patient burden associated with combination therapy comprising individual drugs. The choice of which drugs to administer and the decision to use stepwise vs combination therapy, however, should always be made on an individualized basis.

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Section: Combination Therapymentioning

confidence: 99%

Section: Combination Therapymentioning

confidence: 99%

Section: Combination Therapymentioning

confidence: 99%

Section: Combination Therapymentioning

confidence: 99%

See 2 more Smart Citations

Initiating therapy in patients newly diagnosed with type 2 diabetes: Combination therapy vs a stepwise approach

Cersósimo

Johnson

Chovanes³

et al. 2017

Diabetes Obesity Metabolism

View full text Add to dashboard Cite

show abstract

“…1,2 Treatment with a single glucose-lowering agent will only address limited pathophysiological defects, necessitating the use of multiple medications in most patients to achieve adequate glycaemic control. 1,2 Treatment with a single glucose-lowering agent will only address limited pathophysiological defects, necessitating the use of multiple medications in most patients to achieve adequate glycaemic control.…”

Section: Introductionmentioning

confidence: 99%

Improved glycaemic control and lower hypoglycaemia risk with reduced prior oral antidiabetes drug therapy in patients with type 2 diabetes treated with insulin glargine 300 U/mL

Dailey

Reid

White

et al. 2018

Endocrino Diabet & Metabol

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Summary Aims Data from the EDITION 3 randomized study and the Clinformatics claims database were analysed to determine whether insulin glargine 300 U/mL (Gla‐300) could provide insulin‐naive patients with type 2 diabetes (T2D) on oral antidiabetes drugs (OADs) with reductions in prior OAD therapy without compromising glycaemic control, and while preserving its known low incidence of hypoglycaemia compared with insulin glargine 100 U/mL (Gla‐100). Methods Patient‐level data from EDITION 3 and de‐identified data from the Clinformatics real‐world claims database were analysed. Results At baseline, 70% of patients in EDITION 3 were on a background of ≥2 OADs. Among the 435 and 437 patients who initiated basal insulin with Gla‐300 and Gla‐100, respectively, at Month 6, 336 (77%) and 338 (77%) were using ≤1 OAD. Adding Gla‐300 or Gla‐100 similarly allowed for a reduction in background OAD medication in the Clinformatics dataset (N = 6430), such that, at 6 months postbasal insulin initiation, 14% of patients were no longer taking any OADs. In the analysis of the EDITION 3 study, reduction in OAD burden did not compromise glycaemic benefit, and the low incidence of hypoglycaemia associated with Gla‐300 compared with Gla‐100 was also preserved. Documented symptomatic hypoglycaemia (blood glucose ≤70 mg/dL) occurred in 30.5% vs 41.0% of patients treated with Gla‐300 and Gla‐100, respectively (P = 0.0442). Conclusion Patients with T2D who initiate basal insulin with Gla‐300 could potentially reduce their prior OAD use without compromising glycaemic control and with less hypoglycaemia than with Gla‐100.

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Permanently Charged Cationic Lipids—Evolution from Excipients to Therapeutic Lipids

Banerjee,

Drummond

et al. 2024

Small Science

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Cationic lipids are crucial in medical and biotechnological applications including cellular transfection and gene delivery. Ionizable cationic lipids are critical components of the mRNA‐based COVID vaccines while permanently charged cationic lipids have shown promise in cancer treatment. Despite significant research progress over the past few decades in designing improved, biocompatible cationic lipids, their transfection efficiency remains lower than that of viral vectors. Cationic lipids with additional functionalities like fusogenicity, stimuli‐responsiveness, targeting capabilities, and therapeutic activity have been engineered to improve their performance. This review highlights the importance of molecular hybridization toward the design of biocompatible cationic lipids having fusogenic, stimuli‐responsive, targeting, or therapeutic properties. This review mainly focuses on cationic lipids, having a permanent positive charge in the headgroup region, as these are typically employed to both increase cellular interactions and for improved loading, particularly for anionic nucleic acid‐based therapeutics and vaccines. Structure–activity relationships between the lipid chemical structure (headgroup, spacer, hydrocarbon chain) and, to a lesser extent, the self‐assembled nanostructure and the intrinsic biological activity of the multi‐functional cationic lipids are described. Finally, the challenges involved in developing smart lipids without affecting their inherent capacity to self‐assemble into structured nano‐carriers are discussed.

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Use of oral combination therapy for type 2 diabetes in primary care: Meeting individualized patient goals

Cited by 39 publications

References 86 publications

Initiating therapy in patients newly diagnosed with type 2 diabetes: Combination therapy vs a stepwise approach

Initiating therapy in patients newly diagnosed with type 2 diabetes: Combination therapy vs a stepwise approach

Improved glycaemic control and lower hypoglycaemia risk with reduced prior oral antidiabetes drug therapy in patients with type 2 diabetes treated with insulin glargine 300 U/mL

Permanently Charged Cationic Lipids—Evolution from Excipients to Therapeutic Lipids

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