Combination Therapy of Oral Hypoglycemic Agents in Patients with Type 2 Diabetes Mellitus

Min Kyong Moon

doi:10.4093/jkd.2018.19.1.23

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Moon: Combination Therapy of Oral Hypoglycemic Agents in Patients with Type 2 Diabetes Mellitus

Focused Issue

J Korean Diabetes 2018;19(1):23-30.

Published online: 10 January 2018

DOI: https://doi.org/10.4093/jkd.2018.19.1.23

Combination Therapy of Oral Hypoglycemic Agents in Patients with Type 2 Diabetes Mellitus

Min Kyong Moon

Department of Internal Medicine, SMG-SNU Boramae Medical Center, Seoul National University College of Medicine, Seoul, Korea

Corresponding author: Min Kyong Moon Department of Internal Medicine, SMG-SNU Boramae Medical Center, Seoul National University College of Medicine, 20 Boramae-ro 5-gil, Dongjak-gu, Seoul 07061, Korea, E-mail: mkmoon@snu.ac.kr

Received 26 January 2018 Accepted 5 February 2018

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

The Korean Diabetes Association (KDA) recently updated the Clinical Practice Guidelines on antihyperglycemic agent therapy for adult patients with type 2 diabetes mellitus (T2DM). In combination therapy of oral hypoglycemic agents (OHAs), general recommendations were not changed compared to those of 2015 KDA guidelines. The committee of Clinical Practice Guideline of KDA has extensively reviewed and discussed the results of meta-analyses and systematic reviews of the effectiveness and safety of OHAs and many clinical trials on Korean patients with T2DM for the update of guidelines. All OHAs were effective when added to metformin or metformin and sulfonylurea, although the effects of each agent on body weight and hypoglycemia were different. Therefore, selection of a second agent as a metformin add-on therapy or a third agent as a metformin and sulfonylurea add-on therapy should be based on the patient's clinical characteristics and the efficacy, side effects, cardiovascular benefit, risk of hypoglycemia, effect on body weight, patient preference, and combined comorbidity.

Keywords: Diabetes mellitus, type 2, Hypoglycemic agents, combination, Practice guideline, Treatment outcome

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Fig. 1.

Antihyperglycemic therapy algorithm for adult patients with type 2 diabetes mellitus. SGLT2i, sodium glucose cotransporter 2 inhibitors; TZD, thiazolidinedione; SU, sulfonylurea; DPP4i, dipeptidyl peptidase 4 inhibitors; GLP-1RA, glucagon-like peptide 1 receptor agonists; AGI, alpha glucosidase inhibitors.

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