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Comment je traite... un patient diabétique de type 2 mal contrôlé sous une combinaison metformine plus gliptine. / [How I manage a patient with type 2 diabetes not well controlled with a metformin plus gliptin combination].
Rev Med Liege ; 74(9): 443-450, 2019 Sep.
Artigo em Francês | MEDLINE | ID: mdl-31486312
Type 2 diabetes (T2D) is an evolving disease that requires therapeutic adjustments to maintain adequate glucose control in the long run. An increasing number of patients with T2D are treated with a metformin plus gliptin (DPP-4 Inhibitor) combination, especially those for whom a sulfonylurea is avoided because of a risk of hypoglycaemia. When this dual metformin-gliptin therapy becomes insufficient to reach or maintain adequate glucose control, three solutions may be considered : the addition of a gliflozin (SGLT2 inhibitor), the replacement of the gliptin by a glucagon-like peptide-1 receptor agonist or the addition of a basal insulin whose posology should be progressively up-titrated according to fasting glycaemia. This article describes the pro and contra arguments of these three therapeutic regimens. According to the recent data of the literature, the triple oral therapy combining metformin, a gliptin and a gliflozin appears to offer a favourable alternative in terms of efficacy, tolerance, ease of use, patient adherence and cost.
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Coleções: Bases de dados internacionais Base de dados: MEDLINE Assunto principal: Diabetes Mellitus Tipo 2 / Inibidores da Dipeptidil Peptidase IV / Inibidores do Transportador 2 de Sódio-Glicose / Metformina Tipo de estudo: Guia de prática clínica Aspecto clínico: Etiologia / Terapia Limite: Humanos Idioma: Francês Revista: Rev Med Liege Ano de publicação: 2019 Tipo de documento: Artigo País de afiliação: Bélgica