Diabète de type 2; insuline basale; metformine; inhibiteur de la DPP-4; inhibiteur des SGLT2; sitagliptine; agoniste des récepteurs du GLP-1
Abstract :
[fr] En pratique clinique, de plus en plus de patients diabétiques de type 2 sont traités par
une bithérapie metformine plus gliptine, et pour lesquels un sulfamide hypoglycémiant
avait été évité de peur d’un risque hypoglycémique. Si cette combinaison metformine
plus gliptine devient insuffisante, trois options thérapeutiques peuvent être envisagées :
l’ajout d’une gliflozine (inhibiteur des co-transporteurs sodium/glucose de type 2
[SGLT2]), le remplacement de la gliptine par un agoniste des récepteurs du glucagonlike
peptide-1 (GLP-1), ou l’ajout d’une insuline basale avec une posologie titrée sur la
glycémie à jeun. Cet article décrit les avantages et inconvénients des trois modalités.
Il apparaît, au vu des données de la littérature, que la triple thérapie orale metforminegliptine-
gliflozine offre un ratio favorable, en termes d’efficacité, tolérance, facilité
d’usage, adhésion du patient, et coût. [en] An increasing number of patients with type 2 diabetes are treated with a metformin plus
gliptin combination, especially those for whom a sulfonylurea is avoided because of a
risk of hypoglycemia. When this dual metformin-gliptin therapy becomes insufficient
to reach or maintain adequate glucose control, three solutions may be considered:
the addition of a gliflozin (SGLT2 inhibitor), the replacement of the gliptin by a glucagon-
like peptide-1 receptor agonist (GLP-1 RA), or the addition of a basal insulin
whose posology should be up-titrated according to fasting blood glucose. This article
describes the pros and contras of these three therapeutic regimens. According to the
recent data of the literature, the triple oral therapy combining metformin, a gliptin and
a gliflozin, appears to offer a favourable ratio in terms of efficacy, tolerance, ease of
use, patient adherence, and cost.
SCHEEN, André ; Centre Hospitalier Universitaire de Liège - CHU > Département de médecine interne > Service de diabétologie, nutrition, maladies métaboliques
Language :
French
Title :
Solutions thérapeutiques pour un patient diabétique de type 2 mal contrôlé sous une combinaison metformine plus gliptine
Alternative titles :
[en] Therapeutic alternatives for a patient with type 2 diabetes not well controlled with a metformin plus gliptin combination
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