Diabète de type 2 : pourquoi ne pas proposer une polythérapie antidiabétique d'emblée ?

Type 2 diabetes is due to complex mechanisms involving multiple disorders and organs. The decline in β cells function secreting insulin is the element that determines the deterioration of glycemic control. However, acting on insulin resistance, lipotoxicity and glucotoxicity, is a major determinant of struggle against this metabolic deterioration. We now have more therapeutic classes. Each of them target one or more of the players in this pathogenesis. Therefore, to propose an early combination therapy targeting together several of these disorders appears more relevant than offering a therapeutic step by step approach, waiting months or years after failure, to go from monotherapy to combination therapy. The durability of the effects seems to improve with early combined approach and the use of the best acting classes on this component (glitazones, particularly). On the other hand, this also raises the question of the acceptability by patient of such early combination therapy, of side effects, and of the respective costs of these differing strategies.