The Korean journal of internal medicine

The Korean Association of Internal Medicine (대한내과학회)
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Monotherapy in patients with type 2 diabetes mellitus

  • Rhee, Sang Youl (Department of Endocrinology and Metabolism, Kyung Hee University School of Medicine) ;
  • Kim, Hyun Jin (Division of Endocrinology and Metabolism, Department of Internal Medicine, Chungnam National University School of Medicine) ;
  • Ko, Seung-Hyun (Division of Endocrinology and Metabolism, Department of Internal Medicine, College of Medicine, The Catholic University of Korea) ;
  • Hur, Kyu Yeon (Division of Endocrinology and Metabolism, Department of Internal Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine) ;
  • Kim, Nan-Hee (Division of Endocrinology and Metabolism, Department of Internal Medicine, Korea University College of Medicine) ;
  • Moon, Min Kyong (Division of Endocrinology and Metabolism, Department of Internal Medicine, Seoul Metropolitan Government Seoul National University Boramae Medical Center) ;
  • Park, Seok-O (Department of Internal Medicine, Gwangmyeong Sungae Hospital) ;
  • Lee, Byung-Wan (Division of Endocrinology and Metabolism, Department of Internal Medicine, Yonsei University College of Medicine) ;
  • Choi, Kyung Mook (Division of Endocrinology and Metabolism, Department of Internal Medicine, Korea University College of Medicine) ;
  • Kim, Jin Hwa (Division of Endocrinology and Metabolism, Department of Internal Medicine, Chosun University College of Medicine) ;
  • Committee of Clinical Practice Guideline of Korean Diabetes Association (Korean Diabetes Association)
  • Received : 2017.09.08
  • Accepted : 2017.09.22
  • Published : 2017.11.01
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Abstract

In order to improve the quality of life and to prevent chronic complications related to diabetes mellitus, intensive lifestyle modification and proper medication are needed from the early stage of diagnosis of type 2 diabetes mellitus (T2DM). When using the first medication for diabetic patients, the appropriate treatment should be selected considering the clinical characteristics of the patient, efficacy of the drug, side effects, and cost. In general, the use of metformin as the first treatment for oral hypoglycemic monotherapy is recommended because of its excellent blood glucose-lowering effect, relatively low side effects, long-term proven safety, low risk of hypoglycemia, and low weight gain. If metformin is difficult to use as a first-line treatment, other appropriate medications should be selected in view of the clinical situation. If the goal of achieving glycemic control is not achieved by monotherapy, a combination therapy with different mechanisms of action should be initiated promptly.

Keywords

References

  1. UK Prospective Diabetes Study (UKPDS) Group. Intensive blood-glucose control with sulphonylureas or insulin compared with conventional treatment and risk of complications in patients with type 2 diabetes (UKPDS 33). Lancet 1998;352:837-853. https://doi.org/10.1016/S0140-6736(98)07019-6
  2. Holman RR, Paul SK, Bethel MA, Matthews DR, Neil HA. 10-Year follow-up of intensive glucose control in type 2 diabetes. N Engl J Med 2008;359:1577-1589. https://doi.org/10.1056/NEJMoa0806470
  3. Action to Control Cardiovascular Risk in Diabetes Study Group, Gerstein HC, Miller ME, et al. Effects of intensive glucose lowering in type 2 diabetes. N Engl J Med 2008;358:2545-2559. https://doi.org/10.1056/NEJMoa0802743
  4. ADVANCE Collaborative Group, Patel A, MacMahon S, et al. Intensive blood glucose control and vascular outcomes in patients with type 2 diabetes. N Engl J Med 2008;358:2560-2572. https://doi.org/10.1056/NEJMoa0802987
  5. Duckworth W, Abraira C, Moritz T, et al. Glucose control and vascular complications in veterans with type 2 diabetes. N Engl J Med 2009;360:129-139. https://doi.org/10.1056/NEJMoa0808431
  6. Ismail-Beigi F, Moghissi E, Tiktin M, Hirsch IB, Inzucchi SE, Genuth S. Individualizing glycemic targets in type 2 diabetes mellitus: implications of recent clinical trials. Ann Intern Med 2011;154:554-559. https://doi.org/10.7326/0003-4819-154-8-201104190-00007
  7. Inzucchi SE, Bergenstal RM, Buse JB, et al. Management of hyperglycemia in type 2 diabetes, 2015: a patient-centered approach: update to a position statement of the American Diabetes Association and the European Association for the Study of Diabetes. Diabetes Care 2015;38:140-149. https://doi.org/10.2337/dc14-2441
  8. Look AHEAD Research Group, Wing RR, Bolin P, et al. Cardiovascular effects of intensive lifestyle intervention in type 2 diabetes. N Engl J Med 2013;369:145-154. https://doi.org/10.1056/NEJMoa1212914
  9. Pillay J, Armstrong MJ, Butalia S, et al. Behavioral programs for type 2 diabetes mellitus: a systematic review and network meta-analysis. Ann Intern Med 2015;163:848-860. https://doi.org/10.7326/M15-1400
  10. Turner RC, Cull CA, Frighi V, Holman RR. Glycemic control with diet, sulfonylurea, metformin, or insulin in patients with type 2 diabetes mellitus: progressive requirement for multiple therapies (UKPDS 49). UK Prospective Diabetes Study (UKPDS) Group. JAMA 1999;281:2005-2012. https://doi.org/10.1001/jama.281.21.2005
  11. Ko SH, Hur KY, Rhee SY, et al. Antihyperglycemic agent therapy for adult patients with type 2 diabetes mellitus 2017: a position statement of the Korean Diabetes Association. Diabetes Metab J 2017;41:347-348.
  12. The Korea National Diabetes Program (KNDP) Investigators. Clinical Practice Guideline for the Prevention and Management of Diabetes in Korea. Seoul (KR): Medbook, 2014.
  13. Korean Diabetes Association. 2015 Treatment Guidelines for Diabetes. Seoul (KR): Korean Diabetes Association, 2015.
  14. American Diabetes Association. 8. Pharmacologic approaches to glycemic treatment. Diabetes Care 2017;40(Suppl 1):S64-S74. https://doi.org/10.2337/dc17-S011
  15. McGuire H, Longson D, Adler A, Farmer A, Lewin I; Guideline Development Group. Management of type 2 diabetes in adults: summary of updated NICE guidance. BMJ 2016;353:i1575.
  16. International Diabetes Federation Guideline Development Group. Global guideline for type 2 diabetes. Diabetes Res Clin Pract 2014;104:1-52. https://doi.org/10.1016/j.diabres.2012.10.001
  17. Canadian Diabetes Association Clinical Practice Guidelines Expert Committee, Harper W, Clement M, et al. Pharmacologic management of type 2 diabetes. Can J Diabetes 2013;37 Suppl 1:S61-S68.
  18. Garber AJ, Abrahamson MJ, Barzilay JI, et al. Consensus statement by the American Association of Clinical Endocrinologists and American College of Endocrinology on the comprehensive type 2 diabetes management algorithm: 2017 executive summary. Endocr Pract 2017;23:207-238. https://doi.org/10.4158/EP161682.CS
  19. Bloomgarden ZT, Dodis R, Viscoli CM, Holmboe ES, Inzucchi SE. Lower baseline glycemia reduces apparent oral agent glucose-lowering efficacy: a meta-regression analysis. Diabetes Care 2006;29:2137-2139. https://doi.org/10.2337/dc06-1120
  20. Sherifali D, Nerenberg K, Pullenayegum E, Cheng JE, Gerstein HC. The effect of oral antidiabetic agents on A1C levels: a systematic review and meta-analysis. Diabetes Care 2010;33:1859-1864. https://doi.org/10.2337/dc09-1727
  21. Monnier L, Lapinski H, Colette C. Contributions of fasting and postprandial plasma glucose increments to the overall diurnal hyperglycemia of type 2 diabetic patients: variations with increasing levels of HbA(1c). Diabetes Care 2003;26:881-885. https://doi.org/10.2337/diacare.26.3.881
  22. Bonora E, Muggeo M. Postprandial blood glucose as a risk factor for cardiovascular disease in type II diabetes: the epidemiological evidence. Diabetologia 2001;44:2107-2114. https://doi.org/10.1007/s001250100020
  23. Glucose tolerance and mortality: comparison of WHO and American Diabetes Association diagnostic criteria. The DECODE study group. European Diabetes Epidemiology Group. Diabetes epidemiology: collaborative analysis of diagnostic criteria in Europe. Lancet 1999;354:617-621. https://doi.org/10.1016/S0140-6736(98)12131-1
  24. UK Prospective Diabetes Study (UKPDS) Group. Effect of intensive blood-glucose control with metformin on complications in overweight patients with type 2 diabetes (UKPDS 34). Lancet 1998;352:854-865. https://doi.org/10.1016/S0140-6736(98)07037-8
  25. Goldberg RB, Aroda VR, Bluemke DA, et al. Effect of longterm metformin and lifestyle in the diabetes prevention program and its outcome study on coronary artery calcium. Circulation 2017;136:52-64. https://doi.org/10.1161/CIRCULATIONAHA.116.025483
  26. Bennett WL, Maruthur NM, Singh S, et al. Comparative effectiveness and safety of medications for type 2 diabetes: an update including new drugs and 2-drug combinations. Ann Intern Med 2011;154:602-613. https://doi.org/10.7326/0003-4819-154-9-201105030-00336
  27. Chan JC, Deerochanawong C, Shera AS, et al. Role of metformin in the initiation of pharmacotherapy for type 2 diabetes: an Asian-Pacific perspective. Diabetes Res Clin Pract 2007;75:255-266. https://doi.org/10.1016/j.diabres.2006.06.023
  28. Maruthur NM, Tseng E, Hutfless S, et al. Diabetes medications as monotherapy or metformin-based combination therapy for type 2 diabetes: a systematic review and meta-analysis. Ann Intern Med 2016;164:740-751. https://doi.org/10.7326/M15-2650
  29. Palmer SC, Mavridis D, Nicolucci A, et al. Comparison of clinical outcomes and adverse events associated with glucose-lowering drugs in patients with type 2 diabetes: a meta-analysis. JAMA 2016;316:313-324. https://doi.org/10.1001/jama.2016.9400
  30. Yoon KH, Shin JA, Kwon HS, et al. Comparison of the efficacy of glimepiride, metformin, and rosiglitazone monotherapy in Korean drug-naive type 2 diabetic patients: the practical evidence of antidiabetic monotherapy study. Diabetes Metab J 2011;35:26-33. https://doi.org/10.4093/dmj.2011.35.1.26
  31. Aroda VR, Edelstein SL, Goldberg RB, et al. Long-term metformin use and vitamin B12 deficiency in the diabetes prevention program outcomes study. J Clin Endocrinol Metab 2016;101:1754-1761. https://doi.org/10.1210/jc.2015-3754
  32. Kim YG, Hahn S, Oh TJ, Kwak SH, Park KS, Cho YM. Differences in the glucose-lowering efficacy of dipeptidyl peptidase-4 inhibitors between Asians and non-Asians: a systematic review and meta-analysis. Diabetologia 2013;56:696-708. https://doi.org/10.1007/s00125-012-2827-3
  33. Scirica BM, Bhatt DL, Braunwald E, et al. Saxagliptin and cardiovascular outcomes in patients with type 2 diabetes mellitus. N Engl J Med 2013;369:1317-1326. https://doi.org/10.1056/NEJMoa1307684
  34. White WB, Cannon CP, Heller SR, et al. Alogliptin after acute coronary syndrome in patients with type 2 diabetes. N Engl J Med 2013;369:1327-1335. https://doi.org/10.1056/NEJMoa1305889
  35. Green JB, Bethel MA, Armstrong PW, et al. Effect of sitagliptin on cardiovascular outcomes in type 2 diabetes. N Engl J Med 2015;373:232-242. https://doi.org/10.1056/NEJMoa1501352
  36. Abbas AS, Dehbi HM, Ray KK. Cardiovascular and non-cardiovascular safety of dipeptidyl peptidase-4 inhibition: a meta-analysis of randomized controlled cardiovascular outcome trials. Diabetes Obes Metab 2016;18:295-299. https://doi.org/10.1111/dom.12595
  37. Kongwatcharapong J, Dilokthornsakul P, Nathisuwan S, Phrommintikul A, Chaiyakunapruk N. Effect of dipeptidyl peptidase-4 inhibitors on heart failure: a meta-analysis of randomized clinical trials. Int J Cardiol 2016;211:88-95. https://doi.org/10.1016/j.ijcard.2016.02.146
  38. Zinman B, Wanner C, Lachin JM, et al. Empagliflozin, cardiovascular outcomes, and mortality in type 2 diabetes. N Engl J Med 2015;373:2117-2128. https://doi.org/10.1056/NEJMoa1504720
  39. Monami M, Dicembrini I, Mannucci E. Effects of SGLT-2 inhibitors on mortality and cardiovascular events: a comprehensive meta-analysis of randomized controlled trials. Acta Diabetol 2017;54:19-36. https://doi.org/10.1007/s00592-016-0892-7
  40. Kaku K, Lee J, Mattheus M, et al. Empagliflozin and cardiovascular outcomes in Asian patients with type 2 diabetes and established cardiovascular disease: results from EMPA-REG OUTCOME((R)). Circ J 2017;81:227-234. https://doi.org/10.1253/circj.CJ-16-1148
  41. Neal B, Perkovic V, Mahaffey KW, et al. Canagliflozin and cardiovascular and renal events in type 2 diabetes. N Engl J Med 2017;377:644-657. https://doi.org/10.1056/NEJMoa1611925
  42. Varvaki Rados D, Catani Pinto L, Reck Remonti L, Bauermann Leitao C, Gross JL. The association between sulfonylurea use and all-cause and cardiovascular mortality: a meta-analysis with trial sequential analysis of randomized clinical trials. PLoS Med 2016;13:e1001992. https://doi.org/10.1371/journal.pmed.1001992
  43. Kim SY, Kim HJ, Han KA, et al. Efficacy and safety of mitiglinide in Korean type 2 diabetic patients: prospective randomised multicenter comparative phase III study. J Korean Diabetes Assoc 2007;31:163-174. https://doi.org/10.4093/jkda.2007.31.2.163
  44. Joshi SR, Standl E, Tong N, Shah P, Kalra S, Rathod R. Therapeutic potential of ${\alpha}$-glucosidase inhibitors in type 2 diabetes mellitus: an evidence-based review. Expert Opin Pharmacother 2015;16:1959-1981. https://doi.org/10.1517/14656566.2015.1070827
  45. Dormandy JA, Charbonnel B, Eckland DJ, et al. Secondary prevention of macrovascular events in patients with type 2 diabetes in the PROactive study (PROspective pioglitAzone Clinical Trial In macroVascular Events): a randomized controlled trial. Lancet 2005;366:1279-1289. https://doi.org/10.1016/S0140-6736(05)67528-9
  46. Lincoff AM, Wolski K, Nicholls SJ, Nissen SE. Pioglitazone and risk of cardiovascular events in patients with type 2 diabetes mellitus: a meta-analysis of randomized trials. JAMA 2007;298:1180-1188. https://doi.org/10.1001/jama.298.10.1180
  47. Chiasson JL, Josse RG, Hunt JA, et al. The efficacy of acarbose in the treatment of patients with non-insulin-dependent diabetes mellitus. A multicenter controlled clinical trial. Ann Intern Med 1994;121:928-935. https://doi.org/10.7326/0003-4819-121-12-199412150-00004
  48. Hoffmann J, Spengler M. Efficacy of 24-week monotherapy with acarbose, glibenclamide, or placebo in NIDDM patients. The Essen Study. Diabetes Care 1994;17:561-566. https://doi.org/10.2337/diacare.17.6.561
  49. Holman RR, Cull CA, Turner RC. A randomized double-blind trial of acarbose in type 2 diabetes shows improved glycemic control over 3 years (U.K. Prospective Diabetes Study 44). Diabetes Care 1999;22:960-964. https://doi.org/10.2337/diacare.22.6.960
  50. Black C, Donnelly P, McIntyre L, Royle PL, Shepherd JP, Thomas S. Meglitinide analogues for type 2 diabetes mellitus. Cochrane Database Syst Rev 2007;(2):CD004654.
  51. Chin SO, Rhee SY, Chon S, et al. Hypoglycemia is associated with dementia in elderly patients with type 2 diabetes mellitus: an analysis based on the Korea National Diabetes Program Cohort. Diabetes Res Clin Pract 2016;122:54-61. https://doi.org/10.1016/j.diabres.2016.09.027
  52. Rhee SY, Hong SM, Chon S, et al. Hypoglycemia and medical expenses in patients with type 2 diabetes mellitus: an analysis based on the Korea National Diabetes Program Cohort. PLoS One 2016;11:e0148630. https://doi.org/10.1371/journal.pone.0148630
  53. Cha SA, Yun JS, Lim TS, et al. Severe hypoglycemia and cardiovascular or all-cause mortality in patients with type 2 diabetes. Diabetes Metab J 2016;40:202-210. https://doi.org/10.4093/dmj.2016.40.3.202
  54. Yun JS, Ko SH. Risk factors and adverse outcomes of severe hypoglycemia in type 2 diabetes mellitus. Diabetes Metab J 2016;40:423-432. https://doi.org/10.4093/dmj.2016.40.6.423

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