How I manage a patient with type 2 diabetes not well controlled with a metformin plus gliptin combination
Abstract
Type 2 diabetes (T2D) is an evolving disease that requires therapeutic adjustments to maintain adequate glucose control in the long run. An increasing number of patients with T2D are treated with a metformin plus gliptin (DPP-4 Inhibitor) combination, especially those for whom a sulfonylurea is avoided because of a risk of hypoglycaemia. When this dual metformin-gliptin therapy becomes insufficient to reach or maintain adequate glucose control, three solutions may be considered : the addition of a gliflozin (SGLT2 inhibitor), the replacement of the gliptin by a glucagon-like peptide-1 receptor agonist or the addition of a basal insulin whose posology should be progressively up-titrated according to fasting glycaemia. This article describes the pro and contra arguments of these three therapeutic regimens. According to the recent data of the literature, the triple oral therapy combining metformin, a gliptin and a gliflozin appears to offer a favourable alternative in terms of efficacy, tolerance, ease of use, patient adherence and cost.
Le diabète de type 2 (DT2) est une maladie progressive qui nécessite des ajustements thérapeutiques pour maintenir un bon contrôle glycémique au long cours. Un nombre croissant de patients DT2 traités par une bithérapie metformine plus gliptine (inhibiteur de la DPP-4) sont rencontrés dans la pratique clinique. Chez ces patients, un sulfamide avait été évité de peur d’un risque hypoglycémique. Si cette combinaison metformine plus gliptine…
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