Type 2 diabetes mellitus is a heterogeneous disease with multiple pathophysiological pathways contributing to hyperglycemia, and also resulting in a variable clinical picture. Thus, individualization of hypoglycemic therapy is a mainstay of current clinical guidelines. Several factors should be considered for a given treatment choice. These include the characteristics related to a given medication (efficacy, hypoglycemia, effect on weight, other safety issues, the mechanism of action), and other factors, like costs related to each treatment, convenience for the patient, etc. Initial combination therapy may be considered as a suitable choice for some patients/circumstances. However, the evidence favoring this combinatory initial option has not been clearly established. Different issues concerning the convenience of using either initial combination therapy vs sequential addition of hypoglycemic drugs will be addressed during the discussion. The following aspects will be dealt with: long term efficacy of combination therapy vs sequential titration/addition of hypoglycemic agents; durability; overall cost and cost-effectiveness; safety issues, including hypoglycemia and weight changes; advantages/disadvantages in terms of treatment adherence; effects on patient-oriented outcomes, including long-term morbidity and mortality; effect on clinical inertia; what is the best combination of hypoglycemic agents; individualization vs combination for every patient. To conclude, the question about the implementation of initial combination therapy as a strategy in usual clinical practice is still open.
20 - 23 May 2017
European Society of Endocrinology