The traditional approach to treating patients with newly diagnosed type 2 diabetes has been to recommend improvements to lifestyle, initially. Then if glycemic control cannot be established or maintained, commence the patient on metformin, and then add a sulfonylurea, or other oral agents, as needed. Finally, when all else fails, start insulins.

However, this well recognized paradigm is being challenged. Recent updates to type 2 diabetes guidelines are offering clinicians much greater scope to select the optimal treatment for their patients. Interestingly, research presented at the 2013 American Diabetes Association Scientific Sessions showed that concomitant triple therapy focusing on correcting the pathophysiologic problems associated with the disease provided significantly better effects than a traditional step-wise treatment schedule in newly diagnosed patients (Abdul-Ghani MA, 2013).

Physicians are increasingly taking into account the individual characteristics of each patient and tailoring treatment towards them. For example, the GLP-1 receptor agonists offer significant reductions in weight, a valuable attribute considering many patients with type 2 diabetes are overweight or obese. The SGLT-2 inhibitors work through increasing glucose excretion via the kidney, a novel mechanism of action that key thought leaders believe makes these oral, once-daily agents ideal for concomitant use with other medications. Furthermore, some patients present with severe disease may require the early introduction of insulin to rapidly establish glycemic control.

Metformin's combination of solid efficacy, relative safety, physician familiarity, and perhaps most important, low cost, will see it maintain its dominance in the first-line drug treatment setting. However, some patients cannot tolerate metformin, it may be contraindicated, or the patient's presentation may warrant the use of an alternative therapy. Research conducted by Decision Resources Group found that approximately 30 percent of patients do not receive metformin as a first-line treatment, and that a variety of agents are used in this setting in its place. Considering the prevalence of type 2 diabetes, this presents a major opportunity for drug marketers and developers.

However, with such a broad range of type 2 diabetes therapies available, and many more in the pipeline, antidiabetic agents need to be able to differentiate themselves from the competition. Determining the attributes that physicians and payers see as vital in the first-line treatment of type 2 diabetes will be critical for drug developers and marketers. For primary research and discussion on this topic, click here to access Decision Resources Group's recently published DecisionBase report evaluating a selection of current and emerging therapies, and the market opportunity in this setting.

Tim Blackstock, M.B. Ch.B., M.Phil., is a business insights analyst in the Cardiovascular, Metabolic and Renal Disorders team at Decision Resources Group.

In-depth analysis of type 2 diabetes, with accompanying epidemiology driven sales forecast models, are presented in Decision Resources Group's Type 2 Diabetes Pharmacor.

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