If 2 drugs are unsuccessful, what options for triple-drug therapy are available for type 2 diabetes mellitus (DM)?

Updated: Sep 27, 2021
  • Author: Romesh Khardori, MD, PhD, FACP; Chief Editor: George T Griffing, MD  more...
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If 2 drugs prove unsuccessful after 2-3 months, the next step is triple therapy. The third drug may be an oral agent from a third class of antidiabetic drugs, basal insulin (typically at bedtime), or the injectable drug exenatide. The expense and adverse effect profile of TZDs make their use in an oral triple therapy approach less desirable.

The addition of exenatide to 1 or 2 oral agents (eg, metformin and/or a sulfonylurea) is attractive because of its simplicity (ie, only 2 possible doses of exenatide, with easy titration compared with insulin); although expensive, it avoids hypoglycemia. If basal insulin is used, the insulin dose is titrated to the fasting glucose concentration, which the patient can measure at home.

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