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A different approach is needed for treating type 2 diabetes

Earlier intervention and a new treatment algorithm consisting of a triple treatment approach suggested.

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American Diabetes Association 68th Scientific Sessions

The current approach to diabetes care is not working, according to Ralph A. DeFronzo, MD, and a novel approach to treating type 2 diabetes may be the key.

During this year’s Banting Lecture at the 68th Annual Scientific Sessions of the American Diabetes Association, and in a separate post-meeting interview with Endocrine Today, DeFronzo said that earlier intensive lifestyle intervention, triple therapy and a target HbA1c <6%, in contrast to the ADA recommendation of HbA1c <7% and initial therapy with lifestyle changes and metformin, may be what it takes to help curb increasing rates of type 2 diabetes.

His recommendations are a “paradigm shift that represents a novel approach to the treatment of type 2 diabetes” and are based on years of research and experience in treating patients with diabetes.

Key messages

Earlier lifestyle intervention is essential because diabetes starts much earlier than is typically imagined, according to DeFronzo, professor and chief of the division of diabetes at the University of Texas Health Science Center at San Antonio.

“By the time a patient is diagnosed with diabetes, he/she has lost 80% of their beta cell function. We can’t wait until a person is diabetic to treat severe beta cell dysfunction that is already well advanced,” he said.

Published data shows that diabetes complications, such as retinopathy and neuropathy, already present in about 10% of people with impaired glucose tolerance.

Another key message that DeFronzo shared was that the current treatment guidelines recommended by the ADA do not work. He suggested a new algorithm of “triple drug therapy” that includes metformin, exenatide (Byetta, Amylin) and thiazolidinedione (Actos, Takeda or Avandia, GlaxoSmithKline). He was critical of drugs endocrinologists have used for years, particularly sulfonylureas, due to their lack of effect on the beta cell, and instead suggested newer frontline therapies. When initiated together, at the same time, this algorithm can simultaneously treat the multiple organ dysfunctions related to diabetes, preserve beta cell function and do not cause weight gain or hypoglycemia, according to DeFronzo.

“Diabetes is a complicated disease involving multiple organs and multiple pathways and we need multiple drugs. It is unreasonable to think that one drug is going to correct all of the diabetes-related problems,” he told Endocrine Today. – by Katie Kalvaitis

For more information:

• DeFronzo RA. From the triumvirate to the ominous octet – a new paradigm for the treatment of T2DM. The Banting Lecture. Presented at: American Diabetes Association 68th Scientific Sessions; June 6-10, 2008; San Francisco.