Selecting among ADA/EASD tier 1 and tier 2 treatment options.

Author(s): McGill JB

Affiliation(s): Department of Medicine, Division of Endocrinology, Metabolism and Lipid Research, Washington University School of Medicine, St. Louis, MO, USA.

Publication date & source: 2009-09, J Fam Pract., 58(9 Suppl Treating):S26-34.

Publication type: Review

Each of the 4 groups of medications considered preferred therapies for treatment of T2DM by the ADA/EASD panel--insulin, sulfonylureas, TZDs, and incretin-based therapies (GLP-1 receptor agonists)--possesses significant advantages and disadvantages to be considered when individualizing treatment. Insulin and the sulfonylureas are the most researched therapies available, as well as the most cost-effective and the most effective in achieving glycemic goals. The TZDs have been shown to improve various markers of pancreatic beta-cell function; however, there is a risk of edema and heart failure with the TZDs; rosiglitazone has been associated with an increase in cardiovascular events. GLP-1 receptor agonists and DPP-4 inhibitors address different pathophysiologic causes than do other diabetes medications and offer the benefit of a low incidence of hypoglycemia. Moreover, GLP-1 receptor agonists promote weight loss, whereas DPP-4 inhibitors are generally weight neutral.