Panel Discussion: Is Two Better Than One? The Use of Combination Therapies in Diabetes Care

Robert A. Gabbay, MD, PhD, FACP, chief medical officer at Joslin Diabetes Center, moderates a discussion on the role of combination therapy in several ways, including early aggressive therapy with combination treatment and the combination of taking 2 medications in 1 tablet to encourage adherence with increased convenience and reduced copays. He is joined by S. Sethu K. Reddy, MD, MBA, FRCPC, FACP, MACE; Ravi Retnakaran, MD, MSc, FRCPC; Alexander Turchin, MD, MS; and Helen Feit, MD.
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Robert A. Gabbay, MD, PhD, FACP, chief medical officer at Joslin Diabetes Center, moderates a discussion on the role of combination therapy in several ways, including early aggressive therapy with combination treatment and the combination of taking 2 medications in 1 tablet to encourage adherence with increased convenience and reduced copays. He is joined by S. Sethu K. Reddy, MD, MBA, FRCPC, FACP, MACE; Ravi Retnakaran, MD, MSc, FRCPC; Alexander Turchin, MD, MS; and Helen Feit, MD.

Dr Reddy has found that patients in his practice reaching their ABC goals were on 7 to 8 different medications. He adds that there are numerous reasons why a patient may be hyperglycemic; “it makes intuitive sense that no single drug or single mechanism is going to totally affect [him or her.]” However, Dr Reddy notes that this is a very complicated regime as patients grow older, which he believes impacts quality of life and adherence.

“With combination therapies, we have the potential for sub-maximal doses and lesser side effects,” Dr Retnakaran says. “We also have the possibility of hitting multiple parts of the pathophysiology.”

Dr Retnakaran adds, “Maybe we need to think of diabetes very differently than we currently do and maybe we need to think more like oncologists think.”

Additionally, Dr Turchin notes the importance of acquiring empirical evidence for the benefits and risks that come along with combination therapies, which both the patients and the healthcare system would face.

 
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