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550 Cardio Diabetes Medicine 2017

Cardio Diabetic Therapeutics

When to Use? When Not to Use –OHA

Dr. A. J. Asirvatham MD, D.Diab,
Senior Consultant Diabetologist,
Arthur Asirvatham Hospital, Madurai.

Introduction: The Algorithm:
In the spectrum of treatment of diabetes, when Most of the guidelines recommend Metformin as the
OHAs were born, there was an anticipation that insu- first line of medication following failure of life style
lin would vanish, which never happened. At the time modifications. Subsequently, knowledge about the
of discovery, there were only few molecules making benefits of metformin have improved tremendously
the selection of a drug easy. But now, there are quite making the authorities and guidelines, to promote its
a lot of drugs available which makes it more difficult use as an add on drug along with life style measures
to choose. With more pressure to use newer drugs, (Figure:1). Hence the first anti-diabetic drug is started
the indications and more importantly contraindica- at diagnosis of diabetes.(Fig 1)
tions should be very clearly known. This would help It is customary to wait for an adequate period to al-
not only the patient but also the treating physician low this combination to work. As metformin has to
in achieving good glycemic as well as extra glycemic improve insulin sensitivity, it takes at least two to
benefits.

Figure:1 showing American Diabetes Association 2017
recommendations emphasizing Metformin use along with life style modification.

GCDC 2017