What is the indication for dual-drug therapy in the treatment of type 2 diabetes mellitus (DM)?

Updated: Oct 23, 2019
  • Author: Romesh Khardori, MD, PhD, FACP; Chief Editor: George T Griffing, MD  more...
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Answer

If the patient fails to safely achieve or sustain glycemic goals within 2-3 months, another medication should be added. The choice should be guided by patient characteristics (eg, a DPP-4 inhibitor if both postprandial and fasting glucose levels are elevated; a GLP-1 agonist if postprandial glucose levels are strongly elevated; a TZD if the patient has metabolic syndrome and/or nonalcoholic fatty liver disease). [238]

Failure of initial therapy usually should result in addition of another class of drug rather than substitution. Reserve the use of substitution for cases in which patients experience intolerance to a drug because of adverse effects.


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