How much do the antidiabetic medicines decrease glycosylated haemoglobin

The degree of glycosylated haemoglobin reduction is, apart from any other factor, also dependent on the correct indication for the administration of each medicine separately. As was mentioned before,

First diagnosis of Type 2 diabetes

Change of lifestyle

Smoking cessation

BMI<26

Metformin i

BMI >26

Sulfonylurea or Meglitinide

HbA1c>7%

HbA1c>7%

Addition of sulfonylurea or meglitinide or thiazolidinedione

Addition of metformin

Intolerance to metformin

Insulin

Long acting insulin at bedtime combined with pills (except TZDs)

• Mixture of insulin (rapid acting with slow-acting) twice a day. Discontinuation of pills or continuation of metformin

• Multiple injections regimen if flexibility is required

At any site of the algorithm, acarbose can be added in a progressively higher dose. The same medicine can be administered initially as monotherapy, especially when postprandial hyperglycaemia is more evident.

Note: In cases of obesity, anti-obesity medicines can potentially be prescribed

Figure 27.2. Algorithm of therapeutic approach of a patient with Type 2 DM (Modified from Wallace T.M. and Mastthews D.R.,)

sulfonylureas and metformin decrease the glycosylated haemoglobin by 1.5-2 percent, acarbose by 0.5-1 percent, meglitinides by 0.7-2 percent and glitazones by 1-1.5 percent. The results are dose-dependent and the decrease is usually bigger (>2 percent) when the initial value of glycosylated haemoglobin is higher.

There are differences when the patient receives antidiabetic treatment for the first time or changes treatment due to failure of a previous treatment (smaller decrease in the latter situation). In the second case, the combination of a sulfonylurea with metformin has been calculated to decrease glycosylated haemoglobin by 1.7 percent, the combination of sulfonylurea with acarbose to decrease by 0.9 percent, of megliti-nide with metformin by 1.4 percent, of glitazone with metformin by 0.5-1.5 percent and of glitazone with sulfonylureas by 0.5-1.5 percent.

The combination of a sulfonylurea with rapid-acting insulin decreases the glycosylated haemoglobin by 0.5-1.8 percent, of metformin with rapid-acting insulin by 1.7-2.5 percent, of acarbose with medium-duration insulin by 0.4-0.5 percent, of meglitinides with insulin by 0.7 percent, and of glitazones with insulin (a combination that still has not received approval in Europe) by 0.8-1.4 percent.

It should be noted, however, that these percentages can be used only as general statistical conclusions and not as the necessarily expected response of particular individuals who receive some antidiabetic treatment. This is because the regulation of blood sugar is also the result of proper nutrition and physical activity in addition to pharmaceutical treatment, which should therefore be individualized.

An algorithm for the therapeutic management of DM is shown in Figure 27.2

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