Combination therapy with new targets in Type 2 diabetes: a review of available agents with a focus on pre-exercise...

The current strategy for treating type 2 diabetes mellitus promotes combination therapy to address the 3 major defects in type 2 diabetes mellitus: (1) impaired peripheral glucose uptake (liver, fat, and muscle), (2) excessive hepatic glucose release (with glucagon excess), and (3) insufficient insulin secretion. Providers can prescribe medications that may have advantageous secondary effects in a patient-specific manner. Adjustment for exercise is generally necessary only with insulin and with medications that may allow insulin secretion despite decreasing glucose levels, such as sulfonylurea drugs. Recently, newer oral medications that address beta-cell dysfunction have been designed to avoid hypoglycemia and to "match" nutritional and non-nutritional needs more directly. Incorporating these agents into regimens will likely reduce hypoglycemia and therefore increase the safety and efficacy of exercise as both a treatment and cardiac monitoring strategy for patients with diabetes.