UPDATE ON TREATMENT OF TYPE 2 DIABETES

Abstract

80% patients with type 2 diabete are overweight and obesity. Hyperglycemia almost due to insulin-resistance; In overweight and obese insulin-resistant individuals, modest weight loss has been shown to reduce insulin resistance. Lifestyle changes that include moderate weight loss and regular physical activity (150-300min/week), with dietary strategies including reduced calories and reduced intake of dietary fat, can reduce the risk for developing the complication of diabetes. Therefore, MNT and exercise are the firt choice and metformin. People with diabetes should receive diabetes self-management education to have a good effective in therapy for type 2 diabetes. According to the guidelines in the World, individuals who have type 2 diabetes should receive individualized medical nutrition therapy (MNT) and exercise as needed to achieve treatment goals. In 2008 and update in 2011, 2012, new guideline of the IDC, the ADA and the EASD published an expert consensus statement on the approach to management of hyperglycemia in individuals with type 2 diabetes. Highlights of this approach are: intervention at the time of diagnosis with metformin (monotherapy with metformin as the initial pharmacologic therapy for most patients with type 2 diabetes) in combination with lifestyle changes (MNT and exercise), and continuing timely augmentation of therapy with additional agents (including early initiation of insulin therapy) as a means of achieving and maintaining recommended levels of glycemic control (Fasting plasma glucose or preprandial: 70-130mg/dl, 2 hours posprandial: <180mg/dl and A1C <7% for most patients/3 months). As A1C targets are not achieved, treatment intensification is based on the addition of another agent from a different class (sulfonylureas, meglitinides, thiazolidinediones, DPP-4 inhibitors, and GLP-1 receptor antagonist, insulin). Diabetes in adults is associated with a high risk of macrovascular disease, with CVD the primary cause of death among people with type 2 diabetes. For prevention of cardiovascular events among type 2 diabetes (MI, stroke, PAD..), beside treatment hyperglycemia, we have also to reduce hyperlipidemia and hypertension