Type 2 diabetes: evidence-based medicine approach to glucose-lowering therapy

Type 2 diabetes mellitus is a serious medical and social problem. The danger of the disease is associated with epidemic growth rates and chronic complications, leading to early disability, decreased quality of life and mortality. The prevention of diabetes complications is based on the optimal glucose-lowering therapy with the achievement of target metabolic parameters from the date the diagnosis of T2DM was established and throughout the patient’s life. The complex pathogenetic mechanisms of T2DM are the underlying rationale for drug therapy with a simultaneous effect on various disorders, which will provide a greater hypoglycemic potential and maintain effective glycemic control as T2DM progresses. The main reasons for poor disease control include clinical inertia, untimely intensification of drug therapy, and the use of treatment regimens that are insufficiently effective given the progressive course of the disease. The therapy for T2DM is based on clinical guidelines. The pathogenetic therapy options associated with the use of vildagliptin and metformin are considered. Much attention in modern diabetology is paid to the study of the influence of various therapeutic approaches on the disease progression rates from the perspective of improving prognosis and long-term maintenance of target glycemic control. The advantages of combined glucose-lowering therapy at the onset of T2DM are considered in comparison with the stepwise intensification of glucose-lowering therapy. The VERIFY study examined the long-term efficacy and safety of two treatment approaches: early vildagliptin and metformin combination therapy versus the traditional stepwise approach starting with metformin as initial therapy. The combined glucose-lowering therapy is an important direction in the treatment of patients with newly diagnosed type 2 diabetes.