Oral therapies for diabetic hyperglycemia

Many classes of oral antihyperglycemic agents are available for the treatme nt of type 2 diabetic patients. These classes improve glucose metabolism by different mechanisms, and their effects are additive. Therapy with lifesty le modification and a single oral antihyperglycemic agent infrequently achi eves target glycemic goals, and if it does, the effect usually is not susta ined. A more rational approach is therapy and a combination of drugs with d ifferent mechanisms of action. Initial therapy might be with submaximal con centration of two drugs. As the diabetic abnormalities progress, maximal co ncentrations of the drugs and addition of other classes of oral agents or i nsulin may be needed to maintain the target glycemic goal. In choosing comb inations of oral antihyperglycemic agents, their effects on the components of the insulin resistance syndrome, their side-effect profiles, and the spe cific effects of the agents on glucose metabolism must be considered.