My 32 year old husband, who has had type 2 diabetes for about 10 years, has been in poor control recently with an A1c over 8%, even though he frequently exercises extensively and tries to watch what he eats. He is still slightly overweight but has lots of muscle tone. He actually was under perfect control until his prescription was switched from Glucophage to the generic metformin. As a result, I think that the physician needs to switch his medication. However, the physician has merely added Avandia and a diuretic to his regimen, along with the metformin and high blood pressure medication, and that is not working.

Why do most physicians now just add prescriptions rather than switching to see the effects? My opinion would be that the physician should try to control the individual with the least number of medications due to the potential for side effects of each one and the synergistic effects.

Your question is a fair one. By the time these medications come to market, we have a good idea of how much glucose-lowering they can provide. There is not a single oral agent that can bring the down to normal when the value is over 3% above normal. It is therefore necessary to add agents in a cumulative manner to get the desired effect on overall glucose control. The use of metformin and Avandia [rosiglitazone] is a reasonable combination. They have theoretical synergistic effects for lowering blood sugars. In fact, in several large studies, it has been shown that multiple drugs may be necessary to lower blood sugar control. The same can be said for the number of blood pressure drugs it takes to get patients’ pressure into the desired range.

I know that patients feel that they go to the doctor for diabetes and come with prescriptions for multiple medications. However, that is the nature of the beast. I hope you and your husband remain persistent and strong advocates for your own health care.

JTL