This week brought exciting news for type 2 diabetes patients as well as the medical and public health professionals who are working to control this potentially deadly disease: a new study published in The Lancet suggests that using two common drugs for controlling diabetes in its critical early stages, before lasting damage to organ systems occurs, are far more effective in combination than when delivered alone or in sequence — as directed by the current standard of care. While these findings require further confirmation from additional studies, if confirmed they appear to represent a breakthrough in the treatment of type 2 diabetes that could significantly delay the disease’s progress, allowing millions of newly-diagnosed individuals to live longer lives with fewer painful complications, while saving national healthcare systems billions of dollars.
- The current standard of care, which is based almost entirely on studies of treatment and outcomes of mostly caucasian populations in North America and Europe, calls for treating newly-diagnosed individuals with two drugs in sequence: first metformin, and then when this fails (reflected in the patient’s loss of ability to control blood sugar) it is followed and replaced by vildagliptin or anther oral medicine. However there has been concern that this standard of care didn’t reflect the needs of patients in low- and middle-income countries, where the disease tends to progress faster for a variety of reasons.
- The new study, which took place over seven years, followed over 2,000 newly-diagnosed type 2 diabetes patients over five-year periods for each individual, many of them in low- and middle-income countries in Latin America, Africa and Asia — the first time that research has included subjects from these areas.
- The results clearly showed that combination therapy, using both metformin and vildagliptin, produced major gains in efficacy for newly-diagnosed individuals, reducing the likelihood of treatment failure by 49% compared to treatment with only metformin.
- As an accompanying editorial in The Lancet argues, they strongly suggest that the current standard of care mandating treatment with one drug at a time should be revised. The coming months will doubtless see quite a bit of discussion in the medical and public health communities on this urgent matter.