Treatment strategies and new therapeutic advances for type 2 diabetes

Because type 2 diabetes is caused by two defects, impaired insulin secretion and insulin resistance, logical management of diabetes will include combination therapies to treat this dual condition. Initial combination therapy should include an insulin secretagogue and an insulin sensitizer, with the addition of insulin in the evening if the HbA1c remains greater than 8%. Treatment to target should be clearly defined to achieve HbA1c < 7% unless there are specific individual considerations that make higher HbA1c levels acceptable or desirable. Patients are now treated earlier, when fasting blood glucose levels are in the 126 to 140 mg/dL range; and drugs with less chances of hypoglycemia are preferred at this stage. However, low-dose combination therapy as an early initial treatment, if HbA1c remains > 7%, is an emerging aggressive strategy that requires further consideration and further studies to prove its long-term efficacy and safety.