Pharmacologic Treatment of Type 2 Diabetes

Symposium

Richard Rubin, PhD, CDE
Stuart Chipkin, MD
Matthew Riddle, MD
Irl Hirsch, MD

Reviewed by Joelle Escoffery, PhD

This symposium addressed treatment adherence in type 2 diabetes, selecting and combining oral agents, and different strategies for insulin therapy in type 2 diabetes.  In terms of adherence for pharmacologic treatment with type 2 diabetes, factors associated with adherence include complexity of the regimen, presence of side-effects, financial cost of treatment, and belief that the condition is not serious, and belief that treatment in not effective.  Depression, health literacy, and “psychological insulin resistance” on the part of physicians and patients also contribute to medical adherence. There is on average a 70% to 80% adherence rate for oral medications, and a 65% to 80% adherence rate for insulin use. Strategies for improving adherence include frequent patient monitoring and improved communication between patients and physicians.

Type 2 diabetes treatment generally progresses as β-cell function declines. The typical progression is from lifestyle modification to single oral medication, followed by combination oral medications (two and/or three), and then finally to insulin.  There is evidence to support the continued use of oral medication, even after insulin treatment has been initiated. Additionally, there are a variety of options for insulin therapy available, including basal insulin with NPH or lantus, twice daily with mixed insulin, and finally intensive therapy with multiple daily injections.