Identifying the Principles of Diabetes Treatment

In a presentation focusing on a complications-centric model for overweight and obese patients, Daniel Einhorn provided primary care practitioners with what he hopes is a “logical, straightforward structure for choosing combination therapies” for type 2 diabetes patients.

In “Single, Double, Triple and When to Use Newer Therapies for Diabetes,” Einhorn—medical director at the Scripps Whittier Diabetes Institute, and clinical professor of medicine at the University of California, San Diego—sought to identify the principles of treatment as well as a “rational evolution” in its treatment, re-evaluate the role of injectable agents, describe how to use newer agents that are currently available, and discuss those that are on the horizon.

Einhorn also outlined a pre-diabetes algorithm that included cardiovascular disease risk factors and anti-obesity therapies, as well as anti-hyperglycemic therapies. In discussing the algorithm, Einhorn laid out a number of key principles, such as:

• Lifestyle should not delay medication.

• Multiple medications are typically needed.

• Get to goal ASAP.

• Acquisition cost is not the real or total cost.

• Avoiding hypoglycemia and weight gain is a priority.

• The choice of agent depends on patient comorbidities, preference, simplicity, etc.

• Newer agents make living with diabetes safer and easier.

Einhorn also weighed the “treatment realities” of early versus late prevention and treatment of diabetes. For example, he said, early preventive efforts offer the “maximum benefit,” with minimal medications, hypoglycemia, and monitoring, while late identification and treatment of diabetes often involves multiple medications and insulin, as well as considerable monitoring.

Primary care physicians “lead the way for the practical treatment of diabetes,” says Einhorn, noting that primary care practitioners now “have an online and take-home algorithm that they can refer to in the year to come. They should feel fully confident in using both generics and the newest therapies.”

—Mark McGraw