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Overview

Until recently, standard practice in diabetes treatment has been to employ combination therapy when maximum titration of monotherapy ceases to maintain target glycemic levels. Yet diabetes is a multifactorial disease, primarily resulting from the combination of insulin resistance and progressive beta-cell dysfunction. Emerging treatment paradigms suggest a more aggressive approach, using combination therapy early in the disease process to produce greater reductions in A1C sustained for longer periods of time. Most combination therapy trials have been of a relatively short duration (6-12 months) and have focused on absolute reduction of A1C rather than achieving and sustaining A1C targets. Recently, proof of concept of early combination therapy and most importantly durability of effect has been shown by a trial of rosiglitazone combined with sulfonylurea.

The recent evidence of the benefits of early implementation of combination therapy cannot be ignored. CADRE strongly advocates using aggressive therapeutic measures, including early implementation of combination therapy, to achieve A1C levels as close to normal as possible without unacceptable hypoglycemia.

This guide and slide set was developed for use in a CME Web conference accredited by the University of Texas Southwestern Medical School.