[The importance of integrated treatment of type 2 diabetes]

In recent years, the number of patients with type 2 diabetes in Japan is increasing. It is assumed that two core defects which are insulin resistance as an environmental factor caused by accumulation of fat in adipose cells, liver, and muscles, and insulin deficiency to glucose spike as a genetic factor contribute to the epidemic of type 2 diabetes. It is obvious that type 2 diabetes is closely correlated with a variety of underlying disorders of atherosclerosis. Therefore, it is critical to reduce the development of macrovascular events by integrated treatment which consists of a combination of tight glycemic control with appropriate lipid and hypertension control. In treatment of hypertension, a combination use of antihypertensive agents is common for patients with type 2 diabetes. A couple of fixed dose combinations (FDC) of ARB and thiazide diuretic agent are already in practice for better hypertension management by reduction of the pill burdens on patients to improve drug adherence. In addition, another FDC of ARB and CCB will be also available soon. In treatment of type 2 diabetes, incretin mimetics are drawing physicians' attentions and a novel oral anti-diabetic agent DPP-4 inhibitor is more promising and expected as the first-line therapy. However, further clinical experiences finding out safety and efficacy in a cautious manner are required so that appropriate roles of this agent in treatment algorithm can be built.