Place in Therapy – Combination Therapy
{"Image DocumentName": "Place in Therapy \u2013 Combination Therapy", "Image ImageDescription": "Initial A1c >7.5% \u2013 start dual therapy. Target A1c not reached in 3 months with metformin \u2013 add second agent. No preferred agent to be combined with metformin. SGLT2 inhibitors studies have demonstrated improved glycemic control with combination and add-on therapy. Metformin. Sulfonylurea. Thiazolidinedione. Insulin. Can consider SGLT2 inhibitors in combination with metformin. Patient centered approach \u2013 take into consideration previously mentioned factors, weigh pros and cons of each agent to decide. Some Studies looked at dual and some at triple. Insulin was basal or basal/prandial? Bailey, et al. Add-on to metformin in patients inadequately controlled with metformin alone. Favorable safety parameters and tolerability. Study found improved glycemic control with metformin + SGLT-2 inhibitor. Combination is not associated with risk for hypoglycemia. Add-on to glimepiride in patients poorly controlled sulfonylurea therapy. Significantly improved mean A1C. Reduced weight. Well-tolerated. Add-on to insulin in patients poorly controlled with insulin. Sustained effectiveness and stable tolerability. Less likely to D.C or require insulin up-titration due to poor glycemic control versus placebo. Increased frequency of weight loss and reduced frequency of peripheral edema over time. Diabetes Care 2014;37: S Bailey CJ, et al. Lancet. 2010;375(9733): Strojek K, et al. Abstract 870. EASD Wilding JPH, et al. Abstract 78-OR. ADA Bailey CJ et al. Abstract 988-P. ADA 2011.", "Image XResolution": "37", "Image YResolution": "37", "Image ResolutionUnit": "Pixels/Centimeter", "Image Software": "SlidePlayer", "Image YCbCrPositioning": "Centered"}