Treat-to-target trials in diabetes

Subhash K Wangnoo, Bipin Sethi, Rakesh K Sahay, Mathew John, Samit Ghosal, Surendra K Sharma, Subhash K Wangnoo, Bipin Sethi, Rakesh K Sahay, Mathew John, Samit Ghosal, Surendra K Sharma

Abstract

Treat-to-target is a therapeutic concept that considers well defined and specific physiologic targets as aims in controlling the pathophysiology of the disease. It has been widely used in diseases that pathophysiology includes, chronic metabolic and physiological disturbances, namely rheumatic conditions, vascular medicine and diabetes. In diabetes, the availability of "gold-standard" quantitative measures like fasting plasma glucose and glycated hemoglobin make the application of treat-to-target trials especially pertinent. Treatment modalities which have used single therapeutic agents or combinations or in combination with a variety of titration algorithms and implementation protocols have broadened our understanding of diabetes management with specific reference to insulin initiation and maintenance. Treat-to-target trials have been used to investigate a wide variety of questions including efficacy, safety, effect of treatment on comorbidities and patient satisfaction, ideal mechanisms to implement insulin initiation etc. A more generalized acceptance and implementation of treat-to-target trials may finally revolutionize diabetes management by combining aspects of individual care with standard treatment protocols.

Keywords: Clinical trials; diabetes; efficacy; safety.

Conflict of interest statement

Conflict of Interest: None declared.

Figures

Figure 1
Figure 1
ADA-EASD algorithm for antihyperglycemic therapy in type 2 diabetes[16]. ADA: American Diabetes Association, EASD: European Association for Study of Diabetes, HbA1c: Glycosylated haemoglobin, GI: Gastrointestinal, TZD: Thiazolidinedione, DPP-4 I: Dipeptidyl peptidase-4 inhibitor, GLP-1 RA: Glucagon like peptide-1 receptor agonist, MDI: Multiple daily injections, SU: Sulphonylurea. (a) Consider beginning at this stage in patients with very high HbA1c (e.g., ≥9%), (b) Consider rapid-acting, nonsulfonylurea secretagogues (meglitinides) in patients with irregular meal schedules or who develop late postprandial hypoglycemia on sulfonylureas, (c) additional potential adverse effects and risks may be seen, (d) Usually a basal insulin (NPH, glargine, detemir) in combination with noninsulin agents, (e) Certain noninsulin agents may be continued with insulin

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