Type 2 Diabetes Mellitus Treatment & Management

Updated: Nov 07, 2017

 Author: Romesh Khardori, MD, PhD, FACP; Chief Editor: George T Griffing, MD more...

Approach Considerations

The goals in caring for patients with diabetes mellitus are to eliminate symptoms and to prevent, or
at least slow, the development of complications. Microvascular (ie, eye and kidney disease) risk
reduction is accomplished through control of glycemia and blood pressure; macrovascular (ie,
coronary, cerebrovascular, peripheral vascular) risk reduction, through control of lipids and
hypertension, smoking cessation, and aspirin therapy; and metabolic and neurologic risk reduction,
through control of glycemia.

New abridged recommendations for primary care providers

The American Diabetes Association has released condensed recommendations for Standards of
Medical Care in Diabetes: Abridged for Primary Care Providers, highlighting recommendations most
relevant to primary care. The abridged version focusses particularly on the following aspects:

 Prediabetes

 Self-management education

 Nutrition

 Physical activity

 Smoking cessation

 Psychosocial care

 Immunizations

 Glycemic treatment

 Therapeutic targets

 Diagnosis and treatment of vascular complications

 Intensification of insulin therapy in type 2 diabetes

The recommendations can be accessed at American Diabetes Association DiabetesPro Professional
Resources Online, Clinical Practice Recommendations – 2015.

Type 2 diabetes care is best provided by a multidisciplinary team of health professionals with
expertise in diabetes, working in collaboration with the patient and family. Management includes
the following:

 Appropriate goal setting

 Dietary and exercise modifications

 Medications

 Appropriate self-monitoring of blood glucose (SMBG)

 Regular monitoring for complications

 Laboratory assessment

Ideally, blood glucose should be maintained at near-normal levels (preprandial levels of 90-130
mg/dL and hemoglobin A1C [HbA1c] levels < 7%). However, focus on glucose alone does not provide
adequate treatment for patients with diabetes mellitus. Treatment involves multiple goals (ie,
glycemia, lipids, blood pressure).

Aggressive glucose lowering may not be the best strategy in all patients. Individual risk stratification
is highly recommended. In patients with advanced type 2 diabetes who are at high risk for
cardiovascular disease, lowering HbA1c to 6% or lower may increase the risk of cardiovascular
events.

A study from the ACCORD Study Group found that setting the treatment target for HbA1c below 6%
in high-risk patients resulted in reduced 5-year nonfatal myocardial infarctions. However, patients
who did not achieve the treatment target experienced increased 5-year mortality.

Review of blood glucose logs must be part of any diabetes management plan. Both iron and
erythropoietin treatments commonly prescribed in patients with chronic kidney disease cause a
significant decrease in HbA1c without affecting blood glucose levels.

With each health-care system encounter, patients with diabetes should be educated about and
encouraged to follow an appropriate treatment plan. Adherence to diet and exercise should
continue to be stressed throughout treatment, because these lifestyle measures can have a large
effect on the degree of diabetic control that patients can achieve.
A study by Morrison et al found that more frequent visits with a primary care provider (every 2 wk)
led to markedly rapid reductions in serum glucose, HbA1c, and low-density lipoprotein (LDL)
cholesterol levels. However, how such a strategy can work globally remains a challenge due to
available resources and economic restrictions.

Sumber : https://emedicine.medscape.com/article/117853-treatment