Combination Therapy for Diabetes

The longer you have diabetes, the more likely it is that you'll need additional medications to keep you feeling fit and healthy. Combination therapy--mixing a variety of medicationsmay be just what you need to get your blood sugar right where it belongs. It's an individualized treatment plan that your health care provider will supervise, and one that could change going forward, depending on what your body requires.

"Combination therapy simply means more than one medication, more than one treatment," explains Robin Goland, MD, co-director of the Naomi Berrie Diabetes Center NewYork-Presbyterian Hospital/Columbia University Medical Center in New York City. "It could mean, for instance, combining an insulin sensitizer that is an oral medicine with an injected medicine."

Spyros Mezitis, MD, an endocrinologist at Lenox Hill Hospital, adds that combination therapy works because "diabetes is a multi-faceted disease, and by giving multiple medications, we are attacking each mechanism and trying to improve that one." When combinations of medicines are used, you may take one pill to stimulate your body to produce more insulin and another pill to make your body use that insulin better.

Years ago, combination therapy wasn't even an option since there simply weren't that many medications to treat type 2 diabetes. In the past decade, many more classes of oral medications have been developed and approved for use.

"Now there are multiple medications that can be taken at lower doses," explains Suma Dronavalli, MD, assistant professor of endocrinology at University of Chicago. "You have better control and less possibility of side effects with lower doses of multiple medications." In short, you're attacking the problem at different levels, she explains.

Many diabetics start out on the oral agent Metformin, Dronavalli says. Gradually, as that one doesn't seem as effective, other medications are added.

Some patients don't understand why they should even consider staying on a particular medication that doesn't seem to be working and adding another one, rather than just dropping the first one. In fact, adding that second medication may actually improve the effectiveness of the first one, Dronavalli says. "Each agent can only improve a person's diabetes control so much," she explains. "And if one seems not to be enough, that does not mean it's not working at all."

Generally, the younger you are when you develop Type 2 diabetes, the likelier it is that you'll need to consider combination therapy down the road. Often, diet and exercise are enough to start. But after a few years, a patient may need one medication, and then two or three.

"Usually, it's done as a progression," Goland says. "When one is not enough, you move to the second one."

It's crucial to remember that everyone's diabetes is a little bit different. Some type 2 diabetics may modify their diet, get half an hour of exercise a day and be in good blood sugar control for the next 20 years. Another person may lose 20 pounds and still not be able to get control of the blood sugar.  But even if you're in the second group, don't get discouraged. Combination therapy may be an excellent option for you to discuss with your doctor.