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In terms of dyslipidaemia it is known that pioglitazone is associated with
improvements in triglycerides, HDL cholesterol, LDL particle concentra-
tion, and LDL particle size, whereas rosiglitazone is not. Rosiglitazone
13
has since been associated with a number of adverse effects, but this
example illustrates the point that the variation in efficacy of the various
T2DM treatments, even those in the same therapeutic class, extends
beyond simple glucose lowering.

Obesity can complicate the management of diabetes by increasing
insulin resistance and blood glucose concentrations as well as nega-
tively impacting lipidaemia, but it is well known that some T2DM treat-
14
ments, such as SUs, Glinides, and TZDs are associated with significant
increases in weight. Impact on body weight and in turn lipidaemia
15
will be increasingly recognised as an important measure of efficacy for
new and emerging T2DM treatments. Some new therapies have dem-
onstrated favourable characteristics with regard to body weight. For
example, the DPP-4 inhibitors are weight neutral and the GLP-1 mim-
etics/analogues can reduce body weight significantly. 16-20

Treatment adherence and the needs of the patient

Intimately related to the clinical parameters of efficacy discussed
above is the perennial problem of treatment adherence. The full ben-
efits of a T2DM treatment are only gained if the patient takes the medi-
cations as prescribed. It has been generally acknowledged for years
that non-adherence rates for chronic illness regimens and for lifestyle
changes are ~ 50%. As a group, patients with diabetes find it difficult
21
to adhere to their treatment regimens. 22
Complex regimens

One treatment-related factor that is known to influence adherence is
regimen complexity. It is well known that people with diabetes have
to take several medications every day for their T2DM and concurrent
conditions. Given the fact that patients often have to take different
23
medications, with different dosage frequencies, at different times of
the day, it is hardly surprising that many of them are unable to follow
treatment regimens closely. Simplifying treatment regimens using
23
single pill formulations that can be taken at any time of the day can
potentially help patients to adhere to their medication and consequently
improve the clinical efficacy of T2DM treatments. 21

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