Problems of multiple drug therapy in type 2 diabetes

Abstract

Summary Cardiovascular disease remains the major cause of death of patients with diabetes. This occurs despite numerous drug therapies that have been shown to provide protection from the secondary complications of diabetes. Several studies have shown benefits with aggressive treatment with a single drug therapy, but the STENO-2 study demonstrated benefit with the use of an intensified multifactorial treatment regimen. After follow up, significant reductions in cardiovascular risk, nephropathy, retinopathy, and autonomic neuropathy were demonstrated in the STENO-2. The challenge of the implementation of these study results into clinical practice is problematic. The underutilisation of prophylactic treatments and insufficient lifestyle modifications have resulted in most patients not achieving desired treatment goals. Patient barriers also prevent patients from reaching treatment goals and include the fear of both weight gain and hypoglycaemia, as well as dosing frequency. Numerous studies conclude that simpler dosing is correlated with better patient adherence. The DARTS/MEMO database (2920 subjects) was used to determine that only 31% of those treated with sulphonylurea monotherapy and 34% of those treated with metformin monotherapy reach adequate adherence (defined as >90% of doses taken). The potential benefits of a complex drug regimen will not be obtained until the barrier of poor adherence can be overcome.