{"markup":"\u003C?xml version=\u00221.0\u0022 encoding=\u0022UTF-8\u0022 ?\u003E\n    \u003Chtml version=\u0022HTML+RDFa+MathML 1.1\u0022\n    xmlns:content=\u0022http:\/\/purl.org\/rss\/1.0\/modules\/content\/\u0022\n    xmlns:dc=\u0022http:\/\/purl.org\/dc\/terms\/\u0022\n    xmlns:foaf=\u0022http:\/\/xmlns.com\/foaf\/0.1\/\u0022\n    xmlns:og=\u0022http:\/\/ogp.me\/ns#\u0022\n    xmlns:rdfs=\u0022http:\/\/www.w3.org\/2000\/01\/rdf-schema#\u0022\n    xmlns:sioc=\u0022http:\/\/rdfs.org\/sioc\/ns#\u0022\n    xmlns:sioct=\u0022http:\/\/rdfs.org\/sioc\/types#\u0022\n    xmlns:skos=\u0022http:\/\/www.w3.org\/2004\/02\/skos\/core#\u0022\n    xmlns:xsd=\u0022http:\/\/www.w3.org\/2001\/XMLSchema#\u0022\n    xmlns:mml=\u0022http:\/\/www.w3.org\/1998\/Math\/MathML\u0022\u003E\n  \u003Chead\u003E\u003Cscript type=\u0022text\/javascript\u0022 src=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/sites\/default\/files\/js\/js_itu2PgFdrjV-docKmLK8Jn5oXe_05RgvQh73eOhI_mE.js\u0022\u003E\u003C\/script\u003E\n\u003Cscript type=\u0022text\/javascript\u0022 src=\u0022http:\/\/mdc.sagepub.com\/sites\/all\/modules\/highwire\/highwire\/plugins\/highwire_markup_process\/js\/highwire_at_symbol.js?nzmbo2\u0022\u003E\u003C\/script\u003E\n\u003Cscript type=\u0022text\/javascript\u0022 src=\u0022http:\/\/mdc.sagepub.com\/sites\/all\/modules\/highwire\/highwire\/plugins\/highwire_markup_process\/js\/highwire_article_reference_popup.js?nzmbo2\u0022\u003E\u003C\/script\u003E\n\u003Cscript type=\u0022text\/javascript\u0022 src=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/sites\/default\/files\/js\/js_I8yX6RYPZb7AtMcDUA3QKDZqVkvEn35ED11_1i7vVpc.js\u0022\u003E\u003C\/script\u003E\n\u003Cscript type=\u0022text\/javascript\u0022\u003E\n\u003C!--\/\/--\u003E\u003C![CDATA[\/\/\u003E\u003C!--\n(function(i,s,o,g,r,a,m){i[\u0022GoogleAnalyticsObject\u0022]=r;i[r]=i[r]||function(){(i[r].q=i[r].q||[]).push(arguments)},i[r].l=1*new Date();a=s.createElement(o),m=s.getElementsByTagName(o)[0];a.async=1;a.src=g;m.parentNode.insertBefore(a,m)})(window,document,\u0022script\u0022,\u0022\/\/www.google-analytics.com\/analytics.js\u0022,\u0022ga\u0022);ga(\u0022create\u0022, \u0022UA-15605596-27\u0022, {\u0022cookieDomain\u0022:\u0022auto\u0022});ga(\u0022set\u0022, \u0022page\u0022, location.pathname + location.search + location.hash);ga(\u0022send\u0022, \u0022pageview\u0022);ga(\u0027create\u0027, \u0027UA-189672-26\u0027, \u0027auto\u0027, {\u0027name\u0027: \u0027hwTracker\u0027});\r\nga(\u0027hwTracker.send\u0027, \u0027pageview\u0027);\n\/\/--\u003E\u003C!]]\u003E\n\u003C\/script\u003E\n\u003Cscript type=\u0022text\/javascript\u0022\u003E\n\u003C!--\/\/--\u003E\u003C![CDATA[\/\/\u003E\u003C!--\njQuery.extend(Drupal.settings, {\u0022basePath\u0022:\u0022\\\/\u0022,\u0022pathPrefix\u0022:\u0022\u0022,\u0022highwire\u0022:{\u0022markup\u0022:[{\u0022requested\u0022:\u0022full-text\u0022,\u0022variant\u0022:\u0022full-text\u0022,\u0022view\u0022:\u0022full\u0022,\u0022pisa\u0022:\u0022spmdc;8\\\/7\\\/6\u0022},{\u0022requested\u0022:\u0022long\u0022,\u0022variant\u0022:\u0022full-text\u0022,\u0022view\u0022:\u0022full\u0022,\u0022pisa\u0022:\u0022spmdc;8\\\/7\\\/6\u0022}],\u0022ac\u0022:{\u0022spmdc;8\\\/7\\\/6\u0022:{\u0022access\u0022:{\u0022reprint\u0022:true,\u0022full\u0022:true},\u0022pisa_id\u0022:\u0022spmdc;8\\\/7\\\/6\u0022,\u0022atom_uri\u0022:\u0022\u0022,\u0022jcode\u0022:\u0022spmdc\u0022}}},\u0022googleanalytics\u0022:{\u0022trackOutbound\u0022:1,\u0022trackMailto\u0022:1,\u0022trackDownload\u0022:1,\u0022trackDownloadExtensions\u0022:\u00227z|aac|arc|arj|asf|asx|avi|bin|csv|doc(x|m)?|dot(x|m)?|exe|flv|gif|gz|gzip|hqx|jar|jpe?g|js|mp(2|3|4|e?g)|mov(ie)?|msi|msp|pdf|phps|png|ppt(x|m)?|pot(x|m)?|pps(x|m)?|ppam|sld(x|m)?|thmx|qtm?|ra(m|r)?|sea|sit|tar|tgz|torrent|txt|wav|wma|wmv|wpd|xls(x|m|b)?|xlt(x|m)|xlam|xml|z|zip\u0022,\u0022trackUrlFragments\u0022:1},\u0022ajaxPageState\u0022:{\u0022js\u0022:{\u0022sites\\\/all\\\/libraries\\\/cluetip\\\/jquery.cluetip.js\u0022:1,\u0022sites\\\/all\\\/libraries\\\/cluetip\\\/lib\\\/jquery.hoverIntent.js\u0022:1,\u0022sites\\\/all\\\/libraries\\\/cluetip\\\/lib\\\/jquery.bgiframe.min.js\u0022:1,\u0022sites\\\/all\\\/modules\\\/highwire\\\/highwire\\\/plugins\\\/highwire_markup_process\\\/js\\\/highwire_at_symbol.js\u0022:1,\u0022sites\\\/all\\\/modules\\\/highwire\\\/highwire\\\/plugins\\\/highwire_markup_process\\\/js\\\/highwire_article_reference_popup.js\u0022:1,\u0022sites\\\/all\\\/modules\\\/contrib\\\/google_analytics\\\/googleanalytics.js\u0022:1,\u00220\u0022:1}}});\n\/\/--\u003E\u003C!]]\u003E\n\u003C\/script\u003E\n\u003Clink type=\u0022text\/css\u0022 rel=\u0022stylesheet\u0022 href=\u0022\/\/d282kpwvnogo5m.cloudfront.net\/sites\/default\/files\/cdn\/css\/http\/css_Xg7z6oCTVgud_Q0huYz9x9iiD5H_2YPSJ5z2ZViSWdY.css\u0022 media=\u0022all\u0022 \/\u003E\n\u003Clink rel=\u0027stylesheet\u0027 type=\u0027text\/css\u0027 href=\u0027\/sites\/all\/modules\/contrib\/panels\/plugins\/layouts\/onecol\/onecol.css\u0027 \/\u003E\u003C\/head\u003E\u003Cbody\u003E\u003Cdiv class=\u0022panels-ajax-tab-panel panels-ajax-tab-panel-sageoa-tab-art\u0022\u003E\u003Cdiv class=\u0022panel-display panel-1col clearfix\u0022 \u003E\n  \u003Cdiv class=\u0022panel-panel panel-col\u0022\u003E\n    \u003Cdiv\u003E\u003Cdiv class=\u0022panel-pane pane-highwire-markup\u0022 \u003E\n  \n      \n  \n  \u003Cdiv class=\u0022pane-content\u0022\u003E\n    \u003Cdiv class=\u0022highwire-markup\u0022\u003E\u003Cdiv xmlns=\u0022http:\/\/www.w3.org\/1999\/xhtml\u0022 id=\u0022content-block-markup\u0022 xmlns:xhtml=\u0022http:\/\/www.w3.org\/1999\/xhtml\u0022\u003E\u003Cdiv class=\u0022article fulltext-view \u0022\u003E\u003Cspan class=\u0022highwire-journal-article-marker-start\u0022\u003E\u003C\/span\u003E\u003Cdiv class=\u0022section abstract\u0022 id=\u0022abstract-1\u0022\u003E\u003Ch2\u003ESummary\u003C\/h2\u003E\n            \u003Cp id=\u0022p-1\u0022\u003EThis article presents a debate concerning the merits of different therapies\u0027sulfonylureas, linides, thiazolidinediones, insulins, and incretin-based therapy\u0027for the treatment of diabetes.\u003C\/p\u003E\n         \u003C\/div\u003E\u003Cul class=\u0022kwd-group\u0022\u003E\u003Cli class=\u0022kwd\u0022\u003Ediabetes mellitus\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003Eprevention \u0026amp; screening\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003Eendocrinology\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003Einsulin\u003C\/li\u003E\u003C\/ul\u003E\u003Cdiv class=\u0022section\u0022 id=\u0022sec-1\u0022\u003E\n         \n         \u003Cp id=\u0022p-2\u0022\u003EIn this lively session, presenters debated the merits of different therapies\u2014sulfonylureas, glinides, thiazolidinediones, insulins, and incretin-based therapy\u2014for the treatment of diabetes.\u003C\/p\u003E\n      \u003C\/div\u003E\u003Cdiv class=\u0022section\u0022 id=\u0022sec-2\u0022\u003E\n         \u003Ch2 class=\u0022\u0022\u003ESulfonylureas\u003C\/h2\u003E\n         \u003Cp id=\u0022p-3\u0022\u003ELeif Groop, MD, PhD, Lund University, Malm\u00f6, Sweden, defended the merits of sulfonylureas in the treatment of diabetes. Sulfonylureas, which have been in use since 1948, have well-documented efficacy as antidiabetic agents. New evidence supports the use of sulfonylureas in a broad range of patient subgroups, including patients with diabetes that is caused by mutations in the hepatocyte nuclear factor 1alpha (HNF-1alpha) gene (Pearson ER et al. \u003Cem\u003ELancet\u003C\/em\u003E 2003).\u003C\/p\u003E\n         \u003Cp id=\u0022p-4\u0022\u003ESulfonylureas also have predictable adverse events in patients with type 2 diabetes. The incidence of severe hypoglycemia is approximately 0.8 events per 100 patient-years among those who are treated with sulfonylurea tablets, compared with 11.5 events per 100 patient-years among insulin-treated patients (Leese GP et al. \u003Cem\u003EDiabetes Care\u003C\/em\u003E 2003).\u003C\/p\u003E\n         \u003Cp id=\u0022p-5\u0022\u003EAs with other available antidiabetic treatments, the sulfonylureas and glinides do not change the course of the disease, Prof. Groop said. Regardless of the choice of therapy, the initial benefits of glycemic control are lost over time. In the UK Prospective Diabetes Study (UKPDS; \u003Ca href=\u0022\/external-ref?link_type=ISRCTN\u0026amp;access_num=ISRCTN75451837\u0022 class=\u0022external-ref external-ref-type-isrctn\u0022\u003EISRCTN75451837\u003C\/a\u003E), HbA1c levels rose among patients who were treated with conventional strategies (primarily diet alone), glibenclamide, chlorpropamide, metformin, or insulin (UKPDS. \u003Cem\u003ELancet\u003C\/em\u003E 1998).\u003C\/p\u003E\n         \u003Cp id=\u0022p-6\u0022\u003EGiven the inevitable decline in efficacy, treatment cost becomes particularly important, Prof. Groop argued. He estimated that sulfonylureas are 10 times less expensive than other therapies, including insulin, the glitazones, and protease dipeptidyl peptidase (DPP)-IV inhibitors.\u003C\/p\u003E\n         \u003Cp id=\u0022p-7\u0022\u003E\u201cNo durability has been demonstrated for any of the treatments discussed,\u201d Prof. Groop said. \u201cWhen choosing from a group of poor performers, take the least expensive agent.\u201d This approach can only lead to the selection of sulfonylureas as adjunct therapy to metformin, he concluded.\u003C\/p\u003E\n      \u003C\/div\u003E\u003Cdiv class=\u0022section\u0022 id=\u0022sec-3\u0022\u003E\n         \u003Ch2 class=\u0022\u0022\u003EThiazolidinediones\u003C\/h2\u003E\n         \u003Cp id=\u0022p-8\u0022\u003ERichard W. Nesto, MD, Harvard Medical School, Boston, MA, defended the use of thiazolidinediones in the treatment for hyperglycemia. As a cardiologist, Dr. Nesto said he was particularly interested in the cardiovascular benefits that are associated with thiazolidinediones.\u003C\/p\u003E\n         \u003Cp id=\u0022p-9\u0022\u003EIn 2007, Nissen et al. raised concerns that rosiglitazone increased the risk of cardiovascular death (Nissen SE et al. \u003Cem\u003EN Engl J Med\u003C\/em\u003E. 2007). \u201cThis is a myth,\u201d Dr. Nesto said. Several careful analyses have shown that rosiglitazone does not exacerbate cardiovascular risk in patients with type 2 diabetes (\u003Ca id=\u0022xref-fig-1-1\u0022 class=\u0022xref-fig\u0022 href=\u0022#F1\u0022\u003EFigure 1\u003C\/a\u003E). In fact, thiazolidinediones improve several cardiovascular risk factors. For example, thiazolidinediones reduce blood pressure by an average of 3.5\/1.8 mm Hg. Thiazolidinediones also modify waist-hip ratio, high-density lipoprotein cholesterol (HDL-C), albuminuria, and the presence of inflammatory biomarkers, such as C-reactive protein (CRP).\u003C\/p\u003E\n         \u003Cdiv id=\u0022F1\u0022 class=\u0022fig pos-float  odd\u0022\u003E\u003Cdiv class=\u0022highwire-figure\u0022\u003E\u003Cdiv class=\u0022fig-inline-img-wrapper\u0022\u003E\u003Cdiv class=\u0022fig-inline-img\u0022\u003E\u003Ca href=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/8\/7\/6\/F1.large.jpg?width=800\u0026amp;height=600\u0026amp;carousel=1\u0022 title=\u0022Rosiglitazone Does Not Exacerbate Cardiovascular Risk.\u0022 class=\u0022fragment-images colorbox-load\u0022 rel=\u0022gallery-fragment-images-1426679932\u0022 data-figure-caption=\u0022Rosiglitazone Does Not Exacerbate Cardiovascular Risk.\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003E\u003Cimg class=\u0022fragment-image\u0022 alt=\u0022Figure 1.\u0022 src=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/8\/7\/6\/F1.medium.gif\u0022\/\u003E\u003C\/a\u003E\u003C\/div\u003E\u003C\/div\u003E\u003Cul class=\u0022highwire-figure-links inline\u0022\u003E\u003Cli class=\u00220 first\u0022\u003E\u003Ca href=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/8\/7\/6\/F1.large.jpg?download=true\u0022 class=\u0022highwire-figure-link highwire-figure-link-download\u0022 title=\u0022Download Figure 1.\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EDownload figure\u003C\/a\u003E\u003C\/li\u003E\u003Cli class=\u00221\u0022\u003E\u003Ca href=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/8\/7\/6\/F1.large.jpg\u0022 class=\u0022highwire-figure-link highwire-figure-link-newtab\u0022 target=\u0022_blank\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EOpen in new tab\u003C\/a\u003E\u003C\/li\u003E\u003Cli class=\u00222 last\u0022\u003E\u003Ca href=\u0022\/highwire\/powerpoint\/11164\u0022 class=\u0022highwire-figure-link highwire-figure-link-ppt\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EDownload powerpoint\u003C\/a\u003E\u003C\/li\u003E\u003C\/ul\u003E\u003C\/div\u003E\u003Cdiv class=\u0022fig-caption\u0022 xmlns:xhtml=\u0022http:\/\/www.w3.org\/1999\/xhtml\u0022\u003E\u003Cspan class=\u0022fig-label\u0022\u003EFigure 1.\u003C\/span\u003E \n               \u003Cp id=\u0022p-10\u0022 class=\u0022first-child\u0022\u003ERosiglitazone Does Not Exacerbate Cardiovascular Risk.\u003C\/p\u003E\n            \u003Cdiv class=\u0022sb-div caption-clear\u0022\u003E\u003C\/div\u003E\u003C\/div\u003E\u003C\/div\u003E\n         \u003Cp id=\u0022p-11\u0022\u003EIn major cardiovascular trials, thiazolidinediones have been associated with clinically relevant reductions in atherosclerosis, as measured by carotid intima-media thickness (CIMT) and intravascular ultrasound (IVUS). Thiazolidinediones also have reduced the need for revascularization following percutaneous coronary intervention (PCI).\u003C\/p\u003E\n         \u003Cp id=\u0022p-12\u0022\u003E\u201cThiazolidinediones are the only drug class with a cardiovascular benefit,\u201d Dr. Nesto said. With careful patient selection, thiazolidinediones can provide effective glycemic control while reducing a range of cardiovascular risk factors. Therefore, thiazolidinediones are the best choice for the comprehensive care of patients with type 2 diabetes, he said.\u003C\/p\u003E\n      \u003C\/div\u003E\u003Cdiv class=\u0022section\u0022 id=\u0022sec-4\u0022\u003E\n         \u003Ch2 class=\u0022\u0022\u003EInsulins\u003C\/h2\u003E\n         \u003Cp id=\u0022p-13\u0022\u003EHannele Yki-J\u00e4rvinen, MD, University of Helsinki, Helsinki, Finland, described strategies to maximize the benefits of insulin therapy. In particular, she noted that the recent Action to Control Cardiovascular Risk in Diabetes (ACCORD; \u003Ca class=\u0022external-ref external-ref-type-clintrialgov\u0022 href=\u0022\/lookup\/external-ref?link_type=CLINTRIALGOV\u0026amp;access_num=NCT00000620\u0026amp;atom=%2Fspmdc%2F8%2F7%2F6.atom\u0022\u003ENCT00000620\u003C\/a\u003E) trial illustrated the important balance between the benefit and risk that are associated with intensive glucose control.\u003C\/p\u003E\n         \u003Cp id=\u0022p-14\u0022\u003EIn ACCORD, in intensively treated patients who achieved an HbA1c of 6.4%, there was a notable increase in the risk of cardiovascular deaths, Prof. Yki-J\u00e4rvinen said. Therefore, based on the UKPDS, she suggested that when drugs are used to treat type 2 diabetes, therapeutic glycemic targets should not be lower than 7.0%.\u003C\/p\u003E\n         \u003Cp id=\u0022p-15\u0022\u003EWith the variety of options for reducing HbA1c levels, some physicians may be concerned about the ability of insulin to provide adequate glycemic control, Prof. Yki-J\u00e4rvinen said. However, the HbA1c target of 7.0% has been reached in several recent trials that have incorporated aggressive insulin titration.\u003C\/p\u003E\n         \u003Cp id=\u0022p-16\u0022\u003EWeight gain and hypoglycemia are important potential drawbacks to insulin therapy. Although the HbA1c target of 7.0% can be reached with a variety of insulin-based regimens, analysis of both old and recent evidence in the literature has shown that mixed and prandial\/multiple injections increase weight gain and the incidence of hypoglycemia, compared with regimens that use only basal insulin, regardless of the use of oral hypoglycemic agents. In addition, use of basal insulin analogs reduces hypoglycemia while offering similar glycemic control compared with neutral protamine hagedorn (NPH) insulin.\u003C\/p\u003E\n         \u003Cp id=\u0022p-17\u0022\u003EIn summary, Prof. Yki-J\u00e4rvinen argued that insulin is an effective option for glycemic control in appropriate patients with type 2 diabetes, especially the use of aggressively titrated basal insulin analogs that are combined with oral agents.\u003C\/p\u003E\n      \u003C\/div\u003E\u003Cdiv class=\u0022section\u0022 id=\u0022sec-5\u0022\u003E\n         \u003Ch2 class=\u0022\u0022\u003EIncretin-Based Therapy\u003C\/h2\u003E\n         \u003Cp id=\u0022p-18\u0022\u003EMichael Nauck, MD, PhD, Diabeteszentrum Bad Lauterberg, Bad Lauterberg, Germany, provided a comprehensive review of the strengths and drawbacks of major antidiabetic therapies. In particular, he focused on therapies that are used after metformin fails.\u003C\/p\u003E\n         \u003Cp id=\u0022p-19\u0022\u003EProf. Nauck developed a scoring system to rank therapies on a number of criteria, assigning points for each of the following parameters:\u003C\/p\u003E\n         \u003Cul class=\u0022list-unord \u0022 id=\u0022list-1\u0022\u003E\u003Cli id=\u0022list-item-1\u0022\u003E\n               \u003Cp id=\u0022p-20\u0022\u003Eefficacy with regard to glycemic control\u003C\/p\u003E\n            \u003C\/li\u003E\u003Cli id=\u0022list-item-2\u0022\u003E\n               \u003Cp id=\u0022p-21\u0022\u003Eprevention of microvascular complications\u003C\/p\u003E\n            \u003C\/li\u003E\u003Cli id=\u0022list-item-3\u0022\u003E\n               \u003Cp id=\u0022p-22\u0022\u003Eprevention of macrovascular complications\u003C\/p\u003E\n            \u003C\/li\u003E\u003Cli id=\u0022list-item-4\u0022\u003E\n               \u003Cp id=\u0022p-23\u0022\u003Eattractive mechanism of action\u003C\/p\u003E\n            \u003C\/li\u003E\u003Cli id=\u0022list-item-5\u0022\u003E\n               \u003Cp id=\u0022p-24\u0022\u003Epotential for serious adverse events\u003C\/p\u003E\n            \u003C\/li\u003E\u003Cli id=\u0022list-item-6\u0022\u003E\n               \u003Cp id=\u0022p-25\u0022\u003Epotential for unpleasant side effects\u003C\/p\u003E\n            \u003C\/li\u003E\u003Cli id=\u0022list-item-7\u0022\u003E\n               \u003Cp id=\u0022p-26\u0022\u003Eproven cardiovascular safety\u003C\/p\u003E\n            \u003C\/li\u003E\u003Cli id=\u0022list-item-8\u0022\u003E\n               \u003Cp id=\u0022p-27\u0022\u003Eeffects on body weight\u003C\/p\u003E\n            \u003C\/li\u003E\u003Cli id=\u0022list-item-9\u0022\u003E\n               \u003Cp id=\u0022p-28\u0022\u003Epotential to cause hypoglycemia\u003C\/p\u003E\n            \u003C\/li\u003E\u003Cli id=\u0022list-item-10\u0022\u003E\n               \u003Cp id=\u0022p-29\u0022\u003Eneed for glucose self-monitoring\u003C\/p\u003E\n            \u003C\/li\u003E\u003Cli id=\u0022list-item-11\u0022\u003E\n               \u003Cp id=\u0022p-30\u0022\u003Epotential for durability of glycemic control\u003C\/p\u003E\n            \u003C\/li\u003E\u003Cli id=\u0022list-item-12\u0022\u003E\n               \u003Cp id=\u0022p-31\u0022\u003Edrug costs per day\u003C\/p\u003E\n            \u003C\/li\u003E\u003C\/ul\u003E\n         \u003Cp id=\u0022p-32\u0022\u003EEach parameter received a numerical value that ranged from \u22122 (very negative) to +2 (very positive). Using this system, Prof. Nauck calculated scores for 5 therapeutic groups: sulfonylureas\/glinides; thiazolidinediones; insulin; incretin mimetics; and DPP-IV inhibitors (a subtype of incretin therapy).\u003C\/p\u003E\n         \u003Cp id=\u0022p-33\u0022\u003EIn Prof. Nauck\u0027s analysis, sulfonylureas\/glinides received the lowest score (total score, \u22121), suggesting that they were the least favorable therapeutic option (\u003Ca id=\u0022xref-table-wrap-1-1\u0022 class=\u0022xref-table\u0022 href=\u0022#T1\u0022\u003ETable 1\u003C\/a\u003E). Scoring only slightly higher, insulin (total score, +1) and thiazolidinediones (total score, +1.5) were the next most desirable therapies.\u003C\/p\u003E\n         \u003Cdiv id=\u0022T1\u0022 class=\u0022table pos-float\u0022\u003E\u003Cdiv class=\u0022table-inline\u0022\u003E\u003Cdiv class=\u0022callout\u0022\u003E\u003Cspan\u003EView this table:\u003C\/span\u003E\u003Cul class=\u0022callout-links\u0022\u003E\u003Cli class=\u00220 first\u0022\u003E\u003Ca href=\u0022\/\u0022 class=\u0022table-expand-inline\u0022 data-table-url=\u0022\/highwire\/markup\/11166\/expansion?postprocessors=highwire_figures%2Chighwire_math%2Chighwire_inline_linked_media%2Chighwire_embed\u0026amp;table-expand-inline=1\u0022 html=\u00221\u0022 fragment=\u0022#\u0022 external=\u00221\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EView inline\u003C\/a\u003E\u003C\/li\u003E\u003Cli class=\u00221\u0022\u003E\u003Ca href=\u0022\/highwire\/markup\/11166\/expansion?width=1000\u0026amp;height=500\u0026amp;iframe=true\u0026amp;postprocessors=highwire_figures%2Chighwire_math%2Chighwire_inline_linked_media\u0022 class=\u0022colorbox colorbox-load table-expand-popup\u0022 rel=\u0022gallery-fragment-tables\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EView popup\u003C\/a\u003E\u003C\/li\u003E\u003Cli class=\u00222 last\u0022\u003E\u003Ca href=\u0022\/highwire\/powerpoint\/11166\u0022 class=\u0022highwire-figure-link highwire-figure-link-ppt\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EDownload powerpoint\u003C\/a\u003E\u003C\/li\u003E\u003C\/ul\u003E\u003C\/div\u003E\u003C\/div\u003E\u003Cdiv class=\u0022table-caption\u0022\u003E\u003Cspan class=\u0022table-label\u0022\u003ETable 1.\u003C\/span\u003E \n               \u003Cp id=\u0022p-34\u0022 class=\u0022first-child\u0022\u003ERanking of Second-Line Therapies in Type 2 Diabetes.\u003C\/p\u003E\n            \u003Cdiv class=\u0022sb-div caption-clear\u0022\u003E\u003C\/div\u003E\u003C\/div\u003E\u003C\/div\u003E\n         \u003Cp id=\u0022p-35\u0022\u003EIncretins (total score, +6) and DPP-IV inhibitors (total score, +7) scored markedly higher than their older therapeutic counterparts. With the exception of cost, DDP-IV inhibitors were the only drug class to receive no negative scores on the individual parameters of Prof. Nauck\u0027s scoring system. Incretins received negative scores for the potential for serious or unpleasant side effects and for cost.\u003C\/p\u003E\n         \u003Cp id=\u0022p-36\u0022\u003EBased on his comparison of available agents, Prof. Nauck said that incretin-based therapies, including DPP-IV inhibitors, could become the preferred second-line therapy for patients who have not achieved optimal glycemic control despite lifestyle interventions and metformin therapy.\u003C\/p\u003E\n      \u003C\/div\u003E\u003Cul class=\u0022copyright-statement\u0022\u003E\u003Cli class=\u0022fn\u0022 id=\u0022copyright-statement-1\u0022\u003E\u00a9 2008 MD Conference Express\u003C\/li\u003E\u003C\/ul\u003E\u003Cspan class=\u0022highwire-journal-article-marker-end\u0022\u003E\u003C\/span\u003E\u003C\/div\u003E\u003Cspan id=\u0022related-urls\u0022\u003E\u003C\/span\u003E\u003C\/div\u003E\u003Ca href=\u0022http:\/\/mdc.sagepub.com\/content\/8\/7\/6.abstract\u0022 class=\u0022hw-link hw-link-article-abstract\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EView Summary\u003C\/a\u003E\u003C\/div\u003E  \u003C\/div\u003E\n\n  \n  \u003C\/div\u003E\n\u003C\/div\u003E\n  \u003C\/div\u003E\n\u003C\/div\u003E\n\u003C\/div\u003E\u003Cscript type=\u0022text\/javascript\u0022 src=\u0022http:\/\/mdc.sagepub.com\/sites\/all\/modules\/highwire\/highwire\/plugins\/highwire_markup_process\/js\/highwire_figures.js?nzmbo2\u0022\u003E\u003C\/script\u003E\n\u003Cscript type=\u0022text\/javascript\u0022 src=\u0022http:\/\/mdc.sagepub.com\/sites\/all\/modules\/highwire\/highwire\/plugins\/highwire_markup_process\/js\/highwire_openurl.js?nzmbo2\u0022\u003E\u003C\/script\u003E\n\u003Cscript type=\u0022text\/javascript\u0022 src=\u0022http:\/\/mdc.sagepub.com\/sites\/all\/modules\/highwire\/highwire\/plugins\/highwire_markup_process\/js\/highwire_tables.js?nzmbo2\u0022\u003E\u003C\/script\u003E\n\u003C\/body\u003E\u003C\/html\u003E"}