Sulphonylureas are currently used as initial treatment for most patients. Metformin is used preferentially in very obese, insulin-resistant patients and in those who have experienced adverse effects to sulphonylureas. Acarbose as initial therapy may be particularly useful in those with mild to moderate elevation in HbA1c and those for whom sulphonylureas or metformin may be unsuitable. Examples of the latter include patients at increased risk of hypoglycemia or lactic acidosis such as those of advanced age or with renal insufficiency.
Combination oral therapy should be considered when FPG exceeds 11 mmol/L and HbA1c remains elevated above 8% during monotherapy. Two-drug combinations can be selected from among any of the three classes of oral agents because their mechanisms of action are distinct and clinical benefit should, therefore, be additive. The sequence of addition has not been shown to affect the efficacy of combination therapy (ie, adding metformin to a sulphonylurea produces benefits similar to adding a sulphonylurea to metformin). Get most advantageous deals ever – buy generic Tavist online waiting for you round the clock.