Abstract
Type 2 diabetes mellitus is a serious, chronic, progressive and widespread disease. Metformin is the most commonly prescribed initial therapy, but combination with other antidiabetic agents usually becomes necessary due to the progression of the disease. Pioglitazone is recommended as a second-line therapy because of its strong antihyperglycemic effect and its ability to reduce insulin resistance. Treatment with pioglitazone is associated with a significantly lower risk of cardiovascular complications and hypoglycemia, while simultaneously improving the lipid profile and the symptomatic and histological changes in the liver. Gliptins (sitagliptin and vildagliptin) are a new class of oral antidiabetic drugs which reduce glycated hemoglobin by a different mechanism. Although the efficacy of sitagliptin and vildagliptin is close to that of pioglitazone, the lack of long-term safety data and the higher price question their predominant use. The objective of this review is to highlight the advantages of mono- and combination therapy with pioglitazone in comparison with gliptins and to underline the inconsistencies in the medicinal and reimbursement policy in Bulgaria.
Highlights
Type 2 diabetes mellitus (T2DM) is a global epidemic with an estimated worldwide prevalence of 246 million people (6 %) in 2007 and the number is expected to reach 380 million (7.3 %) by 2025 [1]
According to the therapeutic guidelines of the National Institute for Health and Care Excellence (NICE) glitazones are recommended as second-line therapy in patients who fail to achieve adequate glycemic control (glycated hemoglobin (HbA1c) ≥ 6.5 %) after administration of Filipova et al Diabetology & Metabolic Syndrome (2015) 7:63 metformin and/or sulphonylureas, especially if the person has marked insulin sensitivity [5]
Gliptins are recommended as a second line of therapy, and may be preferable to TZDs in case of problems with weight gain or if the TZD is contraindicated [5]
Summary
Type 2 diabetes mellitus (T2DM) is a global epidemic with an estimated worldwide prevalence of 246 million people (6 %) in 2007 and the number is expected to reach 380 million (7.3 %) by 2025 [1]. Bergenstal et al compared the glycemic effect of pioglitazone and sitagliptin as adjunctive therapy to metformin in patients with T2DM in the study DURATION-2.
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