im clinical pharmacist , i would like to ask why sometimes endocrinologist prefer initiating Pioglitazone with metformin for managing diabetes type 2 patients meanwhile, there are much better treatment option are available managing type 2 diabetes ?
Regards
With so many choices of good antidiabetic drugs available, drugs with side effects like Pioglitazone and Sulphonylureas are rarely needed for patients with Type2 Diabetes (T2D)
Yes, You are right. With weight management, a diabetic diet, and regular exercise the first choice drug is Metformin followed by many good weight reducers and antidiabetics.
These include SGLT-2 inhibitors or Gliflozins (Dapagliflozin, Empagliflozin, and Canagliflozin), DPP-4 agonists, or Gliptins (Sitagliptin, Vildagliptin, Saxagliptin, and Linagliptin), or Incretin mimetics (Liraglutide, and Semaglutide). Other drugs like Glitazones (Pioglitazone), Sulphonylureas (Glibenclamide, Gliclazide, Glipizide, and Glimepiride), and Acarbose are now the last choice.
Anyway, if any type 2 diabetic patient is not controlled with a combination of 1-2 drugs along with Metformin (maximum titrated doses of 2-2.5 Gms), the patient often needs insulin to optimize diabetic control and reach the target HbA1c.
It is case to case basis. All standard guidelines advice to go with metformin and sulphonyl urea.
If expected changes are not achieved additional drugs may be preferred based on the changes in respective fasting or post pradial values.
thanks dear doctors for your valuable comments Muhammad Yousuf and Pugazhenthan Thangaraju
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