New fixed dose chemical combinations: the way forward for better diabetes type II management?

ABSTRACT

Introduction: Diabetes type II is a complex disease with unclear pathophysiology. Lack of adherence and high cost of medicines invariably make the management of diabetes type II highly challenging. Newer fixed drug combinations (FDC) are cost effective and can improve the medication adherence thereby prevent the complications of diabetes. Safety and efficacy of newer FDCs are not well established in all populations. Moreover, extrapolating the efficacy and safety data globally may not be pragmatic. Our review will discuss newer chemical combinations available for the treatment of diabetes type II.

Areas covered: In the present review, the authors discussed the newer FDCs available as add on therapy to the existing pharmacological interventions of diabetes type II that have shown promising results in various randomised trials with regard to efficacy and safety.

Expert opinion: Safety and efficacy data of newer FDCs available as an adjuvant therapy to conventional pharmacological interventions in diabetes type II revealed that fewer new FDCs are promising with their high efficacy and low adverse effect. However, there is a need to explore the place in therapy to establish the utility of FDC in diabetes type II management.

KEYWORDS:

• Combination therapy
• DPP4 inhibitors
• GLP-1 agonist
• newer FDCs
• SGLT2 inhibitors
• type 2 diabetes

Article highlights

• Diabetes mellitus is the multifactorial disease with complex pathophysiology

• Management of diabetes type II is challenging due to inadequate glycaemic control with monotherapy and increased cost of monotherapy.

• Fixed drug combinations (FDCs) are cost effective approach with multiple targets including non-insulin dependent mode of action.

• FDCs can reduce the pill burden to the patient, thereby enhancing the medication adherence which further magnifies the reduction in complications associated with diabetes type II.

• Newer FDCs contains SGLT2 inhibitors and DPP4 inhibitors as add on therapy to metformin and other existing therapies

• Clinical trials reported that there is a significant improvement in HbA1C level and fasting plasma glucose with the use of newer FDCs (P<0.001) and mild to moderate adverse events.

• Future studies are needed to establish the role of newer FDCs regarding the place in therapy.

This box summarizes key points contained in the article.

Declaration of interest

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

Additional information

Funding

This paper was not funded.