Optimizing combination therapy for type 2 diabetes in adolescents and adults: a case-based approach.

Children and adolescents who are overweight and have additional risk factors (ie, high-risk ethnic group or signs of insulin resistance) should be screened for diabetes every 2 years (strength of recommendation [SOR]: C). Management of type 2 diabetes in all age groups requires a multifactorial approach that addresses not only glycemic control (A1C <7%) but also other cardiovascular risk factors such as hypertension, dyslipidemia, and obesity (SOR: A). Most patients with type 2 diabetes will eventually require combination therapy with 2 or more agents to attain and maintain glycemic control (SOR: A). Combining an insulin secretagogue (ie, sulfonylurea or meglitinide) and an insulin sensitizer (ie, metformin or a glitazone) capitalizes on unique mechanisms of action and results in significant A1C lowering (SOR: C). If a patient is unable to achieve glycemic control on 2 oral agents, insulin therapy is an appropriate consideration and should be added to oral agents (rather than substituted) (SOR: B).