Treatment of type 2 diabetes mellitus
People with type 2 diabetes mellitus (DM) are characterised by a resistance to insulin and a relative, as opposed to absolute, insulin deficiency. At least initially, and often throughout their lifetime, they do not need exogenous insulin for survival. Thus, although insulin may be required for controlling hyperglycaemia, these patients do not develop diabetic ketoacidosis other than in rare situations.1
In this article, treatment of chronic hyperglycaemia associated with various organ system dysfunctions will be discussed. The treatment of complications (microvascular [retinopathy, nephropathy, neuropathy] and macrovascular [cardiovascular, cerebrovascular and peripheral vascular diseases]) is beyond the scope of the article.
Goals of treatment
The goals of therapy for type 2 DM include:
- Correction of symptoms such as polyuria, nocturia, blurred vision, tiredness, pruritus vulvae in women and balanoposthitis in men
- Prevention of macrovascular and microvascular complications
- Maintenance of a healthy, cheerful life free of the fear of DM
It is worth emphasising that type 2 DM is a complex metabolic disorder, and good diabetic control should include maintaining a normal body mass index, blood pressure (Figure 1) and lipid levels.
The best way of assessing glycaemic control is by estimating the glycosylated haemoglobin (HbAlc) level. Lowering the HbAlc to less than 2 per cent above the upper limit of normal (or less than 7 per cent, as in the Diabetes Control and Complication Trial [DCCT]2 standard) should be the goal for which to aim. For some patients, this is difficult and often impractical, such as in the presence of significant co-morbid illness, old age, and in people with a defective state of mind. In routine clinical practice, an HbAlc less than 8 per cent should be acceptable. In certain situations, such as in pregnancy, control should be very strict. Also, it is important to clarify to readers at the beginning that intensive glycaemic control does not mean multiple insulin injections, the use of insulin pumps or the checking of blood sugar levels 10 times a day. Intensive glycaemic control simply implies that the blood glucose level should be kept as near normal as possible and hypoglycaemia avoided, no matter how simple or complex the treatment regimen is.
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Citation: Hospital Pharmacist URI: 10974273
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