Thomas Jefferson University, Pa.

I'm Dr. Barry Goldstein, the director of the Division of Endocrinology, Diabetes, and Metabolic Diseases at Thomas Jefferson University Thomas Jefferson University in Philadephia. As patients with type 2 diabetes know, it is important to get their blood sugars under aggressive control in order to prevent the long-term complications of this disease, especially damage to the eyes and the kidneys. Even the American Diabetes Association in their most recent treatment guidelines have suggested the initial use of metformin, along with diet and exercise, at the time of diagnosis. This is because we don't think the patient should delay their management, and they should try to get their blood sugars under control as quickly as possible, hopefully within 6 months from the time of diagnosis -- and we know that most patients need medications to do this.

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It's also become apparent that combinations of medications can work faster and more effectively, and also can be safe when used earlier, even at the initial stages of diagnosis, and it's because the medications that we have available work with different mechanisms, that these mechanisms can be put together strategically to control blood sugars.

Diabetes has several causes in the body, and the available medications can work on different aspects of what's causing the blood sugars to go up. One recent trial used a relatively new medication called sitagliptin in initial combination with metformin in patients who have never been treated with drug therapy before. And I was involved in this trial -- we recently had a publication on this -- and the initial combination of sitagliptin and metformin worked better than either drug alone, and was able to get 66 percent of the treated patients to their glucose goals, as defined by the American Diabetes Association, within 6 months of treatment. I think in the future we're going to be seeing more initial therapy and earlier therapy with combinations of the available medications we have, and getting to the glucose goals is critically important in preventing the complications of diabetes.

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