We are all familiar with Metformin (Glucophage) knowing it is the first drug prescribed for our Type-2 Diabetic (T2DM) patients. As we are all aware, rarely is this monotherapy effective unless our patient makes the necessary lifestyle modifications. Most references show that only 7% of T2DM patients will make the necessary lifestyle/dietary modifications necessary to combat this disease that is now affecting 1 out of 10 Americans. For the other 93% of our patients we need to look at additional pharmacotherapy to manage their Type-2 Diabetes.
Even with drug treatment Type-2 diabetics, will eventually need additional therapy to treat their hyperglycemia.
- After 3 years, 50% of patients will need a second drug
- After 9 years, nearly 75% will need the second drug added.
- Most common combination therapy if cost is a concern is sulfonylurea + metformin.
- As diabetes progresses a third drug is often added—either another oral agent, GLP-1, or insulin.
- Addition of insulin should NOT be postponed in patients with poor glycemic control that have failed on multiple drug regimens.
- Look at the patient, consider need for weight loss, adherence, insurance coverage, cost of medications etc.
PUTTING IT ALL TOGETHER FOR COMBINATION THERAPY
|Treatment||Expected decrease in HbA1c||Estimated monthly cost|
|Exercise, diet weight loss||1-2%|
|Sulfonylurea (glipizide, glimepiride, eglyburide)||1.5%||$8.00|
|Alpha glucosidase inhibitors (Precose/Glyset)||0.5-0.8%||$22.00|
|Incretins (Victoza, Trulicity, Ozempic)||1-1.5%||$800.00|
|DPP4 inhibitors (Januvia, Tradjenta)||0.5-1%||$500.00|
|SGLT2 inhibitors ((Invokana, Jardiance, etc)||0.5-1%||$550.00|
|insulin -basal 1 vial||1.5-3.5%||$320.00|
*Consider initial therapy with insulin if HbA1c is greater than 10%, fasting glucose is over
Example: the goal A1C you set is 7% for example.
If a patient comes in with a HbA1c =9 there is NO way he can get there by adding Januvia®!
Your Thompson Pharmacist can help you and your physician decide what treatment options are best for you. Go Ahead and Ask, at Thompson Pharmacy It’s All for YOU!