Alogliptin-Pioglitazone Combination Therapy: A Rational Approach to Treating Type 2 Diabetes Mellitus

Introduction: Type 2 diabetes mellitus (T2DM) is a complex disease with a number of metabolic abnormalities. At present, treatment typically proceeds in a stepwise fashion, beginning with diet and exercise followed by incremental additions of oral antidiabetic agents as required to achieve and maintain glycemic control (glycosylated hemoglobin [HbA1c] ≤6.9% and 6.5%, respectively). This approach is reactive rather than proactive as progression to the next level is based on treatment failure (i.e., not achieving target HbA1c levels). Newer approaches to treatment of T2DM advocate early use of combination antihyperglycemic regimens with complementary mechanisms of action to correct multiple pathophysiologic defects, but this can impact negatively on treatment adherence. Fixed-dose combinations are associated with higher compliance rates than therapy with individual components administered concomitantly. This review examines evidence for a fixed-dose combination of alogliptin and pioglitazone recently approved for use in Japanese patients with T2DM.