Exploring Treatment Strategies for Type 2 Diabetes

Abstract

Perspectives on the News commentaries are now part of a new, free monthly CME activity. The Mount Sinai School of Medicine, New York, New York, is designating this activity for 2.0 AMA PRA Category 1 credits. If you wish to participate, review this article and visit www.diabetes.procampus.net to complete a posttest and receive a certificate. The Mount Sinai School of Medicine is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians . This is the second in a series of articles based on presentations at the American Diabetes Association's 67th Scientific Sessions in June 2007, in Chicago, discussing approaches to the treatment of type 2 diabetes, contrasting the use of older therapies with the use of new agents to lower blood glucose levels. At a symposium on the use of insulin in treatment of type 2 diabetes, Rury Holman (Oxford, U.K.) reviewed the findings of the UK Prospective Diabetes Study (UKPDS) and A Diabetes Outcome Progression Trial (ADOPT) in terms of the performance of metformin, sulfonylureas, thiazolidinediones, and insulin. Among the newly diagnosed diabetic individuals entering the UKPDS, mean A1C fell from 9 to 7% with diet modification. At 1 year, mean A1C was 6% with insulin, sulfonylurea, and metformin treatment. After 3, 6, and 9 years in UKPDS, however, only ∼40, 40, and 30% of individuals receiving insulin maintained A1C <7%. Among those on sulfonylurea monotherapy, 45% had A1C <7% at 3 years, but the proportions decreased to 30 and 20% at 6 and 9 years, respectively, with 45, 35, and 15% of those receiving metformin monotherapy maintaining A1C <7% at these times. Holman characterized this inexorable increase as one of the principal challenges of glycemic treatment of individuals with type 2 diabetes. Interestingly, the widely used sulfonylurea glyburide was less …