Chapter

Pharmacotherapy in type 2 diabetes: clinical evidence

Gayatri Sreemantula, Santosh Shankarnarayan and Jiten P Vora

in Type 2 Diabetes

Second edition

Published on behalf of Oxford University Press

Published in print May 2010 | ISBN: 9780199596171
Published online January 2012 | e-ISBN: 9780191739699 | DOI: http://dx.doi.org/10.1093/med/9780199596171.003.0045

Series: Oxford Diabetes Library

Pharmacotherapy in type 2 diabetes: clinical evidence

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• Patients with type 2 diabetes demonstrate increased cardiovascular risk; this risk is significantly reduced by improved glycaemic control • Recent trials have demonstrated that both low and high mean HbA1c values are associated with increased all-cause mortality and cardiac events • UKPDS and further Cochrane analysis showed that metformin improves glycaemia, is weight neutral and possesses positive cardiovascular profile. Lactic acidosis, in one systematic analysis, is proved to be extremely rare and prevalence may be similar to placebo in low risk groups • Thiazolidinediones are efficacious, combine well with other agents for diabetes and show good durability, They are associated with weight gain, increase risk of (non-fatal) heart failure and increase risk of small bone fracture in women. Rosiglitazone (but not pioglitazone) has been associated with increased risk of myocardial infarction and the European Medicines Agency has recently recommended suspension of all authorization of its use • Sulfonylureas are efficacious, with rapid onset of action and combine well with other agents for diabetes in the European Union diabetes. They are associated with weight gain and increased risk of hypoglycaemia • Initial addition of basal insulin to oral therapy followed by subsequent intensification to a basal-prandial regimen would be the ideal insulin treatment strategy • Current evidence is suggestive of a potential association between use of analogue insulins and increased cancer incidence and would warrant further investigations.

Chapter.  8147 words.  Illustrated.

Subjects: Endocrinology and Diabetes

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