DPP-4 or SGLT2 inhibitor added to metformin alone in type 2 diabetes
Abstract
After failure of a monotherapy with metformin, dipeptidyl peptidase-4 inhibitors (gliptins) and sodium-glucose cotransporters type 2 (gliflozins) offer an alternative to the add-on of a sulphonylurea, especially in diabetic patients at risk of hypoglycaemia. The choice between a gliptin and a gliflozin may be guided by the individual patient characteristics : rather a gliptin in a patient without obesity or severe hyperglycaemia, in an elderly patient, with a frailty profile or with renal impairment; rather a gliflozin in an obese patient, with hypertension, hyperuricaemia, antecedents of cardiovascular disease (especially heart failure), without advanced renal insufficiency and with a low risk of urinary/genital infections or events linked to dehydration such as hypotension.
Après échec d’une monothérapie par metformine, les inhibiteurs de la dipeptidyl peptidase-4 (gliptines) et les inhibiteurs des cotransporteurs sodium-glucose de type 2 (gliflozines) offrent une alternative à un traitement par sulfamides, en particulier chez les patients diabétiques à risque d’hypoglycémie. Le choix peut être orienté en fonction des caractéristiques individuelles du patient considéré : plutôt une gliptine chez un patient pas trop obèse ni trop hyperglycémique, relativement âgé, avec un profil fragilisé, éventuellement insuffisant rénal ; plutôt une gliflozine chez un patient obèse, hypertendu, hyperuricémique, avec des antécédents cardiovasculaires (insuffisance cardiaque), sans…
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