Glyxambi (Empagliflozin/Linagliptin): A Dual-Acting Oral Medication Approved for the Treatment of Patients with Type 2 Diabetes.

More than 29 million individuals in the United States have diabetes; of these, approximately 21 million people are diagnosed, and 8 million individuals remain undiagnosed and untreated.1 Type 2 diabetes, which accounts for the large majority of new diagnoses of diabetes, is a leading cause of morbidity, including cardiovascular disease, blindness, renal failure, amputations, and hospitalizations.1,2 Type 2 diabetes is also associated with an increased risk for cancer, psychiatric illness, cognitive decline, chronic liver disease, arthritis, and other disabling conditions.2 Type 2 diabetes is a disorder in which the cells in the muscles, liver, and fat tissue are unable to use insulin effectively.1 As the body's need for insulin increases, the beta cells in the pancreas lose their ability to produce sufficient quantities of the hormone. The relative role of insulin resistance compared with beta-cell dysfunction varies; some individuals are primarily insulin resistant, and others use insulin effectively but have low insulin secretion.1 The risk for type 2 diabetes increases with older age, obesity, family history of diabetes, history of gestational diabetes, impaired glucose metabolism, and physical inactivity.1 The prevalence and the incidence of type 2 diabetes continue to escalate worldwide, resulting in a significant economic burden for healthcare systems.2 The American Diabetes Association (ADA) estimates that the total (direct and indirect) cost of diabetes in the United States was $245 billion in 2012; the direct medical costs were $176 billion, and the indirect costs, including disability, work loss, and premature death, totaled approximately $69 billion.3 The treatment goals for patients with type 2 diabetes include the elimination of symptoms and the prevention of complications. Dietary and exercise modifications, as well as patient education, remain the cornerstones of initial treatment of patients with type 2 diabetes.2 Antidiabetic medications are considered when these interventions are insufficient to maintain near-normal blood glucose levels and the patient's target hemoglobin (Hb) A1c level.2 In recent years, glycemic management of patients with type 2 diabetes has become increasingly complex and even controversial.2 New pharmacologic agents for type 2 diabetes have been introduced at a rapid rate, each with potential adverse effects. In addition, the benefits of intensive glucose control in preventing macrovascular complications remain uncertain. According to a joint position statement issued by the ADA and the European Association for the Study of Diabetes, metformin monotherapy represents the standard treatment for patients with diabetes at diagnosis, unless explicitly contraindicated.2 If a patient's HbA1c target level is not reached after approximately 3 months, one of several drugs can be combined with metformin.2 Drug classes and drugs that can be considered for adjunctive use with metformin include2: Sulfonylureas (glipizide, glimepiride, glyburide) Thiazolidinediones (pioglitazone) Dipeptidyl peptidase (DPP)-4 inhibitors (alogliptin, linagliptin, saxagliptin, sitagliptin, vildagliptin) Glucagon-like peptide (GLP)-1 receptor agonists (albiglutide, dulaglutide, exenatide, liraglutide) Insulins (glargine, lispro) Sodium-glucose transporter (SGLT)2 inhibitors (canagliflozin, empagliflozin). Typically, the choice of treatment should be made on the basis of patient and medication characteristics, with the primary goal of improving glycemic control and minimizing the side effects.2