Hormonal
Treatment-resistant type 2 diabetes, defined as failure to achieve HbA1c targets despite triple oral therapy (metformin, sulfonylurea, and a third agent), can be effectively managed by adding a DPP-4 inhibitor and an SGLT2 inhibitor to metformin, or by combining basal insulin with a GLP-1 receptor agonist or SGLT2 inhibitor.
If your blood sugar remains high despite taking three oral diabetes medications (metformin, a sulfonylurea, and another), ask your doctor about adding a DPP-4 inhibitor and an SGLT2 inhibitor. These oral drugs work together to lower blood sugar effectively. If you are already on insulin, adding a GLP-1 receptor agonist or an SGLT2 inhibitor can improve control, reduce insulin dosage, and help with weight loss without increasing hypoglycemia risk.
If treatment resistant diabetes is defined as not achieving glycated haemoglobin target despite oral triple therapy with a third glucose-lowering agent added to metformin-sulfonylurea dual treatment, the combination of a dipeptidyl peptidase-4 (DPP-4) inhibitor and a sodium glucose cotransporter type 2 (SGLT2) inhibitor may offer new opportunities before considering injectable therapies. Insulin basal therapy (± metformin) may be optimized by the addition of a SGLT2 inhibitor or a glucagon-like peptide-1 (GLP-1) receptor agonist.
Why this rating
The paper is a narrative review citing multiple meta-analyses and clinical trials, providing strong evidence for the efficacy of these combinations.
Source
Pharmacotherapy of ‘treatment resistant’ type 2 diabetes
André Scheen · Expert Opinion on Pharmacotherapy · 2017
DOI 10.1080/14656566.2017.1297424
More from this paper
- Combining basal insulin with a GLP-1 receptor agonist (GLP-1RA) significantly reduces HbA1c, body weight, and hypoglycemia risk compared to basal insulin alone or intensified insulin regimens.Strong
- Combining a GLP-1 receptor agonist (GLP-1RA) with an SGLT2 inhibitor provides superior glucose control, greater weight loss, and greater reductions in systolic blood pressure compared to either drug alone.Good
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