Oral anti diabetic polychemotherapy in type 2 diabetes mellitus

The therapeutic guidelines of the seventies for type 2 diabetic patients was a monotherapy which choice was based on the BMI of the patient and a bitherapy in case of a blood glucose increase. The pathophysiologic knowledge on type 2 diabetes has moved and the disease is nowadays more complex with a loss of the beta cell mass and an insulin resistance state of the liver, muscle and adipocyte tissue associated with a defect in gastro-intestinal hormones in the postprandial state. The pathophysiologic knowledge and the existence of new therapeutic agents led us to discuss oral antidiabetic polychemotherapy at the first drug prescription. This intuitive proposition has no evidence-based arguments with prospective long-term studies that would demonstrate the benefit of such a proposition. Moreover, if nowadays we can imagine a tritherapy proposition, progress in chemistry research will conduct to a quadri- and penta-therapy with expected difficulties in therapeutic compliance of the patient.