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Combined treatment of type 2 diabetes
E. Menéndez Servicio de Endocrinología. Hospital de Navarra. Pamplona. |
 Type
2 diabetes at present represents a challenge to public health throughout the
world. Its incidence is increasing in a considerable way and, therefore,
cardiovascular morbi-mortality associated with macro or micro-angiopathy. The
prevention of vascular complications in these patients must include control of
all the cardiovascular risk factors as well as of glycemia. In recent years it
has been shown that the control of the latter has to be much more strict and
that in many cases monotherapy does not achieve the established aims. At the
same time, new oral anti-diabetic medicines have recently appeared with
different mechanisms of action. The
possible combinations of treatment with different oral anti-diabetics, or else
with oral anti-diabetics with insulin, are very numerous and have shown their
effectiveness in reducing glycemia and the glycosylated haemoglobin. This is why
the combined treatment is at present an alternative to insulinisation in
monotherapy for patients with type 2 diabetes and bad control in monotherapy. In
this paper the available scientific evidence on each one of the combinations and
their possible indications is reviewed. Selection
of the type of association necessary will depend on the individual aims of
control, on the physiopathological mechanism presumably involved in each case,
on the efficacy, cost and secondary effects of each medicine, as well as on the
characteristics of each patient. Key
words. Type 2
diabetes. Combined treatment. Oral anti-diabetics.
Correspondencia: Aceptado para su publicación el 6 de mayo de 2002. |
