Speaker: Date: Topic
Greeshma K. Shetty, MD
Sep 25, 2013
Type 2 Diabetes: Optimizing Medical Management in 2013
Responsibility for Contente
The take-away points and article links were sent by the Medical Library and the CME Committee.
Diane E. Young, Information Specialist
Take-Away Points of the Presentation
1. Type 2 Diabetes Mellitus affects 25.8 million people in the United States; in particular, it affects 26.9% of people over the age of 65. Diabetes carries an increased risk for heart disease, stoke, hypertension, blindness, kidney disease, nervous system disease, and amputations. Studies in the US and abroad have found that improved glucose control benefits people with either type 1 or type 2 diabetes. In general, every percentage point drop in A1C blood test results can reduce the risk of microvascular complictions -- eye, kidney, and nerve diseases.
2. Type 2 Diabetes is most frequently detected by primary care physicians (PCPs) when a higher than normal glucose level or HbA1c is noted at a yearly physical in an unsuspecting patient. Given that PCPs are those who most frequently detect and initially treat type 2 diabetes, it is essential that they are educated in the proper work-up, treatment options, and follow-up for these patients.
3. Initial treatment for type 2 diabetes consists of education and lifestyle modifications, namely, nutrition, exercise and weight loss. Monotherapy with Metformin is indicated in most patients; some patients do require insulin treatment initially at time of diagnosis. Most patients have improved glucose control initially,but with time due to progressive beta cell dysfunction other treatments need to be considered and added to the treatment regimen. There are many medications to chose from, including: Sulfonylureas, Meglitinides, Thiazolidinediones, DPP-IV inhibitors, Glucagon-like peptide 1 agonists, Alpha-glucosidase inhibitors, and Insulin.
Links to Articles Cited in the Presentation
- ADA: Standards of medical care in diabetes - 2011. Diabetes Care 2011 Jan;34 Suppl 1:S11-61.
- Aschner P et al: Effect of the dipeptidyl peptidase-4 inhibitor sitagliptin as monotherapy on glycem
- Bailey CJ & Turner RC: Metformin. NEJM 1996 Feb 29;334(9):574-9
- Bennett WL et al: Comparative effectiveness and safety of medications for type 2 diabetes: an update
- Blevins T et al: DURATION-5: exenatide once weekly resulted in greater improvements in glycemic cont
- Buse JB et al: Amylin replacement with Pramlintide in type 1 and type 2 diabetes: A physiological ap
- Buse JB et al: Effects of exenatide (exendin-4) on glycemic control over 30 weeks in sulfonylurrea-t
- Chao EC & Henry RR: SGLT2 inhibition - a novel strategy for diabetes treatment. Nat Rev Drug Discov
- Davies MJ: Insulin secretagogues. Curr Med Res Opin 2002;18 Suppl 1:s22-30.
- DeFronzo RA et al: Effects of exenatide (exendin-4) on glycemic control and weight over 30 weeks in
- DeFronzo RA: Bromocriptine: a sympatholytic, d2-dopamine agonist for the treatment of type 2 diabete
- Del Prato S et al: Improving glucose management: ten steps to get more patients with type 2 diabetes
- Diamant M & Heine RJ: Thiazolidinediones in type 2 diabetes mellitus: current clinical evidence. Dru
- Drucker DJ: Glucagon-like peptides. Diabetes 1998 Feb;47(2):159-69.
- Eng J et al: Isolation and characterization of exendin-4, an exendin-3 analogue, from Heloderma susp
- Flint A et al: Glucagon-like peptide 1 promotes satiety and suppresses energy intake in humans. J Cl
- Garber AJ et al: Am Assoc of Clin Endocrinologists' comprehensive diabetes management algorithm 2013
- Gaziano JM et al: Randomized clinical trial of quick-release bromocriptine among patients with type
- Holman RR: Assessing the potential for alpha-glucosidase inhibitors in prediabetic states. Diabetes
- Inzucchi SE et al: Management of hyperglycemia in type 2 diabetes: a patient centered approach: posi
- Ismail-Beigi F et al: Individualizing glycemic targets in type 2 diabetes mellitus: implications of
- Larsson H et al: Glucagon-like peptide-1 reduces hepatic glucose production indirectly through insul
- Lebovitz HE: alpha-Glucosidase inhibitors. Endocrinol Metab Clin North Am 1997 Sep;26(3):539-51.
- Nair S & Wilding JP: Sodium glucose cotransporter 2 inhibitors as a new treatment for diabetes melli
- Nathan DM et al: Medical management of hyperglycemia in type 2 diabetes: a consensus algorithm for t
- Nauck MA et al: Effects of subcutaneous glucagon-like peptide 1 (GLP-1[7-36 amide]) in patients with
- Ooi CP & Loke SC: Colesevelam for type 2 diabetes mellitus. Cochrane Database Syst Rev 2012 Dec;12:C
- Setter SM et al: Metformin hydrochloride in the treatment of type 2 diabetes mellitus: a clinical re
- UKPDS Group: Effect of intensive blood-glucose control with metformin on complications in overweight
- United Kingdom Prospective Diabetes Study (UKPDS). 13: Relative efficacy of randomly allocated diet,
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