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Alan J. Garber, MD, PhD

Arch Intern Med. 2003;163:1781-1782.

	Since this article does not have an abstract, we have provided the first 150 words of the full text and any section headings.

INTRODUCTION

IN THE 40 years since their introduction, oral hypoglycemic agents have become the cornerstone of pharmacologic therapy in type 2 diabetes mellitus. The 5 classes of oral agents now available are sulfonylureas, meglitinides, thiazolidinediones, biguanides, and -glucosidase inhibitors. However, initial therapy with any of these agents ultimately fails as the result of a gradual loss of -cell insulin secretory response to glucose. Treatment with an oral agent is often initiated as monotherapy; as glycemic control progressively worsens, a second agent is added in combination. The reported failure rates for single oral agents—5% to 20% per year—suggest that single oral therapy in type 2 diabetes succeeds for approximately 5 years. When therapy with multiple oral agents fails, exogenous insulin is required and is usually added to 1 or more of the existing regimen of oral agents. A large body of evidence suggests that insulin therapy should . . . [Full Text of this Article]

COMBINATION STUDIES WITH INSULIN AND ORAL AGENTS

Sulfonylureas and Insulin

Metformin and Insulin

Thiazolidinediones and Insulin

Insulin Analogues and Oral Agents

CONCLUSIONS

From the Baylor College of Medicine, Houston, Tex. The author has received research support from Bristol-Myers Squibb, GlaxoSmithKline, Tadeka, Novo Nordisk, Schering-Plough, Pfizer, Pharmacia & Upjohn, Novartis, Roche, Astra-Zeneca, and Restoragen; has acted as consultant for Bristol-Myers Squibb, GlaxoSmithKline, and Novo Nordisk; and is a member of the speakers bureau of Bristol-Myers Squibb, GlaxoSmithKline, Eli Lilly, Novo Nordisk, Pfizer, Wyeth-Ayerst, and Aventis.

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Insulin and Oral Hypoglycemic Agents Should Not Be Used in Combination in the Treatment of Type 2 Diabetes
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Arch Intern Med. 2003;163(15):1783-1785.
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Rebuttal by Dr Garber
Alan J. Garber
Arch Intern Med. 2003;163(15):1785.
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